Measuring Patient Mobility in the ICU Using a Novel Noninvasive Sensor.

OBJECTIVES: To develop and validate a noninvasive mobility sensor to automatically and continuously detect and measure patient mobility in the ICU. DESIGN: Prospective, observational study. SETTING: Surgical ICU at an academic hospital. PATIENTS: Three hundred sixty-two hours of sensor color and depth image data were recorded and curated into 109 segments, each containing 1,000 images, from eight patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three Microsoft Kinect sensors (Microsoft, Beijing, China) were deployed in one ICU room to collect continuous patient mobility data. We developed software that automatically analyzes the sensor data to measure mobility and assign the highest level within a time period. To characterize the highest mobility level, a validated 11-point mobility scale was collapsed into four categories: nothing in bed, in-bed activity, out-of-bed activity, and walking. Of the 109 sensor segments, the noninvasive mobility sensor was developed using 26 of these from three ICU patients and validated on 83 remaining segments from five different patients. Three physicians annotated each segment for the highest mobility level. The weighted Kappa (κ) statistic for agreement between automated noninvasive mobility sensor output versus manual physician annotation was 0.86 (95% CI, 0.72-1.00). Disagreement primarily occurred in the "nothing in bed" versus "in-bed activity" categories because "the sensor assessed movement continuously," which was significantly more sensitive to motion than physician annotations using a discrete manual scale. CONCLUSIONS: Noninvasive mobility sensor is a novel and feasible method for automating evaluation of ICU patient mobility.

Biochemical characterization of P4-ATPase mutations identified in patients with progressive familial intrahepatic cholestasis.

Mutations in the P4-ATPase ATP8B1 cause the inherited liver disease progressive familial intrahepatic cholestasis. Several of these mutations are located in conserved regions of the transmembrane domain associated with substrate binding and transport. Assays for P4-ATPase-mediated transport in living yeast cells were developed and used to characterize the specificity and kinetic parameters of this transport. Progressive familial intrahepatic cholestasis mutations were introduced into the yeast plasma membrane P4-ATPase Dnf2p, and the effect of these mutations on its catalysis of phospholipid transport were determined. The results of these measurements have implications for the basis of the disease and for the mechanism of phospholipid transit through the enzyme during the reaction cycle.

Advancing alternatives assessment for safer chemical substitution: A research and practice agenda.

Alternatives assessment has emerged as a science policy field that supports the evaluation and adoption of safer chemistries in manufacturing processes and consumer products. The recent surge in the development and practice of alternatives assessment has revealed notable methodological challenges. Spurred by this need, we convened an informal community of practice comprising industry experts, academics, and scientists within government and nongovernmental organizations to prioritize a research and practice agenda for the next 5 years that, if implemented, would significantly advance the field of alternatives assessment. With input from over 40 experts, the agenda outlines specific needs to advance methods, tools, and guidance in 5 critical areas: hazard assessment, comparative exposure characterization, life cycle considerations, decision making, and professional practice. Fifteen research and practice needs were identified, ranging from relatively simple efforts to define a minimum hazard data set to the development of more complex performance and decision-analytic methods and data integration tools. Some research needs involve adapting existing approaches to the alternatives assessment context, while others will require the development of entirely new methods and tools. The proposed research and practice agenda is ambitious. Implementing it will require expanding the current network of researchers from academia, government, and industry, as well as increased funding for methodological, application, and evaluation research. Integr Environ Assess Manag 2018;00:000-000. © 2018 SETAC.

Dioxins, metals, and fish toxicity in ash residue from space heaters burning used motor oil.

Ash residue, generated from burning used motor oil, is a complex and ubiquitous waste stream. Ash samples were collected from space heaters and analyzed for dioxins (N=10), expressed as toxic equivalents (TEQ), and heavy metals (N=9). TEQ averaged 148-164 ng kg(-1) (standard deviation [SD] 385-416 ng kg(-1)), depending on methods used for non-detects (NDs) and toxic equivalency factors (TEFs). It is notable that median TEQ (2.89-3.49 ng kg(-1)) was about 50 fold lower, reflecting the influence of several high end values on the mean. The proportion of NDs among 17 polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) in each sample averaged 38.2% (range 0-94.1%). Total metals averaged 103,000 mg kg(-1) (SD 26,600 mg kg(-1)), with Zn, Cu, and Pb contributing 89.3%, 6.4%, and 3.0% of the total, respectively. Rainbow trout bioassays resulted in median mortalities of 3.2% and 42.0% (respective SD 25.3% and 43.2%) at ash concentrations of 10 and 100 mg l(-1), respectively. Nominal concentrations of several metals (e.g., Cu, Zn) in the fish bioassay exceeded their reported median lethal concentrations (LC50s) for the test species. Multiple regressions (Bonferroni P<0.05) demonstrated that most of the variance in fish mortality could be accounted for by pH, metals (e.g., As, Cd, Pb), and TEQ. Mean TEQ concentration in used oil ash ranked on the high end of TEQ content in other environmental matrices, including wood ash, cement kiln dust, biosolids, and soils. Overall, these results suggest that suitable disposal methods are needed for ash generated from burning used motor oil.

Outside of the box: recent news about phospholipid translocation by P4 ATPases.

The P4 subfamily of P-type ATPases includes phospholipid transporters. Moving such bulky amphipathic substrate molecules across the membrane poses unique mechanistic problems. Recently, three papers from three different laboratories have offered insights into some of these problems. One effect of these experiments will be to ignite a healthy debate about the path through the enzyme taken by the substrate. A second effect is to suggest a counterintuitive model for the critical substrate-binding site. By putting concrete hypotheses into play, these papers finally provide a foundation for investigations of mechanism for these proteins.

The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital.

BACKGROUND: Traditionally, cholecystectomy for cholecystitis is performed within 3 days of the onset of symptoms or after 5 weeks, allowing for resolution of the inflammatory response. This study reviewed the outcomes of cholecystectomy performed for patients with gallstone disease in the acute (n = 45), intermediate (n = 55), and delayed (n = 102) periods after the onset of symptoms. METHODS: The medical records of 202 patients who underwent laparoscopic cholecystectomy at a large municipal hospital were reviewed retrospectively. The primary outcomes studied were length of hospital stay, conversion to open cholecystectomy, and complications. RESULTS: There was no significant difference in the conversion rate (acute [18%] vs intermediate [20%] vs delayed [11%]) or complication rate (acute [16%] vs intermediate [9%] vs delayed [7%]) among the 3 groups. The delayed group had a significantly shorter length of hospital stay than the intermediate or acute group (3.1 +/- 3.8 vs 4.3 +/- 3.8 vs 1.7 +/- 2.1, respectively, P < .001). CONCLUSIONS: Patients who present with acute symptoms of cholecystitis should undergo surgery during the same admission, regardless of the duration of symptoms.