Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients*.

OBJECTIVE: We investigated the epidemiology of ventilator-associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes. DESIGN: Secondary analysis of a multicenter prospective cohort (EU-VAP project). SETTING: Twenty-seven European ICUs. PATIENTS: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-aged (45-64 yr; n = 670), old (65-74 yr; n = 549), and very old patients (≥ 75 yr; n= 516). MEASUREMENTS AND MAIN RESULTS: Ventilator-associated pneumonia occurred in 103 middle-aged (14.6%), 104 old (17.0%), and 73 very old patients (12.8%). The prevalence (n ventilator-associated pneumonia/1,000 ventilation days) was 13.7 in middle-aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-associated pneumonia. Ventilator-associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24% in middle-aged, 32% in old, and 43% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-associated pneumonia onset, new temperature rise was less frequent among very old patients (59% vs 76% and 74% for middle-aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-associated pneumonia was higher among elderly patients: 35% in middle-aged patients versus 51% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95% CI, 1.2-3.9 and adjusted odds ratio for very old age, 2.3; 95% CI, 1.2-4.4). Other risk factors for mortality in ventilator-associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent. CONCLUSIONS: In this multicenter cohort study, ventilator-associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae.

Direct observation of degassing during decompression of basaltic magma.

Transitions in eruptive style during volcanic eruptions strongly depend on how easily gas and magma decouple during ascent. Stronger gas-melt coupling favors highly explosive eruptions, whereas weaker coupling promotes lava fountaining and lava flows. The mechanisms producing these transitions are still poorly understood because of a lack of direct observations of bubble dynamics under natural magmatic conditions. Here, we combine x-ray radiography with a novel high-pressure/high-temperature apparatus to observe and quantify in real-time bubble growth and coalescence in basaltic magmas from 100 megapascals to surface. For low-viscosity magmas, bubbles coalesce and recover a spherical shape within 3 seconds, implying that, for lava fountaining activity, gas and melt remain coupled during the ascent up to the last hundred meters of the conduit. For higher-viscosity magmas, recovery times become longer, promoting connected bubble pathways. This apparatus opens frontiers in unraveling magmatic/volcanic processes, leading to improved hazard assessment and risk mitigation.

Dendritic crystallization in hydrous basaltic magmas controls magma mobility within the Earth's crust.

The majority of basaltic magmas stall in the Earth's crust as a result of the rheological evolution caused by crystallization during transport. However, the relationships between crystallinity, rheology and eruptibility remain uncertain because it is difficult to observe dynamic magma crystallization in real time. Here, we present in-situ 4D data for crystal growth kinetics and the textural evolution of pyroxene during crystallization of trachybasaltic magmas in high-temperature experiments under water-saturated conditions at crustal pressures. We observe dendritic growth of pyroxene on initially euhedral cores, and a surprisingly rapid increase in crystal fraction and aspect ratio at undercooling ≥30 °C. Rapid dendritic crystallization favours a rheological transition from Newtonian to non-Newtonian behaviour within minutes. We use a numerical model to quantify the impact of rapid dendritic crystallization on basaltic dike propagation, and demonstrate its dramatic effect on magma mobility and eruptibility. Our results provide insights into the processes that control whether intrusions lead to eruption or not.

In situ observation of nanolite growth in volcanic melt: A driving force for explosive eruptions.

Although gas exsolution is a major driving force behind explosive volcanic eruptions, viscosity is critical in controlling the escape of bubbles and switching between explosive and effusive behavior. Temperature and composition control melt viscosity, but crystallization above a critical volume (>30 volume %) can lock up the magma, triggering an explosion. Here, we present an alternative to this well-established paradigm by showing how an unexpectedly small volume of nano-sized crystals can cause a disproportionate increase in magma viscosity. Our in situ observations on a basaltic melt, rheological measurements in an analog system, and modeling demonstrate how just a few volume % of nanolites results in a marked increase in viscosity above the critical value needed for explosive fragmentation, even for a low-viscosity melt. Images of nanolites from low-viscosity explosive eruptions and an experimentally produced basaltic pumice show syn-eruptive growth, possibly nucleating a high bubble number density.

Nanoscale uniform self-assembled monolayers of fluorescent zinc(II) complexes on the Si(100) surface.

The synthesis of self-assembled monolayers on Si(100) substrates of a new fluorescent Zn(II) Schiff-base complex is reported. Chemisorbed species are characterized by the combination of fluorescence scanning near-field optical/atomic force microscopy (SNOM/AFM), and by fluorescence spectroscopy. Both SNOM/AFM results indicate the existence of a monolayer on the surface, while optical SNOM images highlight the contribution of the monolayer to the local fluorescence. While chemisorbed molecular monolayers exhibit a distinct fluorescence, analogous to that observed in solution, cast thin films do not show any emission. Photoluminescent properties of the monolayer can be related to its nanoscale uniform, ordered structure.

Cost analysis of blood purification in intensive care units: continuous versus intermittent hemodiafiltration.

BACKGROUND: We implemented a program for continuous renal replacement therapies (CRRT) in intensive care units (ICU) based on the cooperative work of dialysis and ICU personnel. Our aim was to report the main details of this program and compare its cost with that of intermittent hemodiafiltration (IHDF). METHODS: The study referred to 181 ICU patients with renal failure. We considered the costs of both technical devices and assisting personnel. CRRT was performed as continuous veno-venous hemodiafiltration (CVVHDF) (24 hr daily); dialysis and ICU nurses shared surveillance. Only dialysis nurses performed IHDF (as acetate-free biofiltration, 4 hr daily) in the ICU. RESULTS: The daily cost of CRRT was Euro 276.70; of which 79% was for devices and 21% was for human resources. Nurse surveillance required 141 min per day, ICU nurses supplied 55% (77 min) and dialysis nurses 45% (64 min). On average, CRRT surveillance required less than 1 min/nurse/hr for both dialysis and ICU nurses. The daily cost of 4-hr IHDF sessions of was Euro 247.83, of which 44% was for technical devices and 56% was for human resources. CONCLUSIONS: The cooperation between dialysis and ICUs improved the use of human resources and allowed us to supply CRRT to all critically ill patients with acute renal failure. The expenditure for CRRT was 12% higher than that for IHDF, due to the cost of technical devices.

Engineering coordination assemblies of dinuclear CuII complexes.

Hybrid organic-inorganic coordination assemblies are synthesized using modified aminocarboxylic acid ligands as the structure-directing agents. The synthetic approach results in two novel dinuclear copper(II) complexes, K2[CuII(hnida)]2.2H2O (1) and K4[CuII(chnida)]2.4H2O.4MeOH (2) that assemble in the presence of suitable counterions into a densely packed hexagonal array or an open-framework structure. The functionality of the aminocarboxylic acid ligands provides a tool to control the supramolecular structure. The materials combine promising thermal stabilities with the necessary flexibility to withstand structural changes induced by calcinations or the uptake and release of guest molecules. The structural and physicochemical properties of the complexes were investigated using X-ray diffraction, magnetic measurements, thermogravimetric analysis and spectroscopy.

Marginal adaptation of fixed prosthodontics: a new in vitro 360-degree external examination procedure.

PURPOSE: This study evaluated the marginal fit of experimental and custom-made fixed prosthetic restorations through a new 360-degree external examination. The minimum number of gap measurements required to produce relevant results for gap analysis was also investigated. MATERIALS AND METHODS: The marginal fit of six experimental and eight custom-made crowns was observed microscopically by means of a mechanical device, and software was employed to measure the gap. Two crowns, chosen from among the 14 previously evaluated, were reanalyzed to determine the minimum number of gap measurements required to produce significant results for gap analysis. RESULTS: The precision obtained with the custom-made crowns differed from that of the experimental specimens. The minimum number of measurements required to produce a sample mean value within +/- 5 microm of the mean, calculated over 360 measurements, taking standard error of the means < or = 4 microm, was 18 for experimental and 90 for custom-made crowns, for both equidistant measurement spacing and randomly selected points. CONCLUSION: Differences in fit between experimental specimens and custom-made ones showed that experimental results might not always be obtained in clinical practice. Within the limitations of the protocol of this study, the minimum number of measurements required to ensure relevant results for gap analysis was 18 for experimental and 90 for custom-made crowns.