Association between inflammation and post-intensive care syndrome: a systematic review.

Post-intensive care syndrome describes the physical, cognitive and emotional symptoms which persist following critical illness. At present there is limited understanding of the pathological mechanisms contributing to the development of post-intensive care syndrome. The aim of this systematic review was to synthesise current evidence exploring the association between inflammation and features of post-intensive care syndrome in survivors of critical illness. Relevant databases were systematically searched for studies of human participants exposed to critical illness. We sought studies that reported results for biomarkers with an identified role in the pathophysiology of inflammation obtained at any time-point in the patient journey and an outcome measure of any feature of post-intensive care syndrome at any point following hospital discharge. We included 32 studies, with 23 in the primary analysis and nine in a brain injury subgroup analysis. In the primary analysis, 47 different biomarkers were sampled and 44 different outcome measures were employed. Of the biomarkers which were sampled in five or more studies, interleukin-8, C-reactive protein and interleukin-10 most frequently showed associations with post-intensive care syndrome outcomes in 71%, 62% and 60% of studies, respectively. There was variability in terms of which biomarkers were sampled, time-points of sampling and outcome measures reported. Overall, there was mixed evidence of a potential association between an inflammatory process and long-term patient outcomes following critical illness. Further high-quality research is required to develop a longitudinal inflammatory profile of survivors of critical illness over the recovery period and evaluate the association with outcomes.

Dynamic evanescent phonon coupling across the La(1-x)Sr(x)MnO3/SrTiO3 interface.

The transport and magnetic properties of correlated La0.53Sr0.47MnO3 ultrathin films, grown epitaxially on SrTiO3, show a sharp cusp at the structural transition temperature of the substrate. Using a combination of experiment and first principles theory we show that the cusp is a result of evanescent cross-interface coupling between the charge carriers in the film and a soft phonon mode in the SrTiO3, mediated through linked oxygen octahedral motions. The amplitude of the mode diverges at the transition temperature, and phonons are launched into the first few atomic layers of the film, affecting its electronic state.

Chemistry of ferroelectric surfaces.

It has been recognized since the 1950s that the polar and switchable nature of ferroelectric surfaces can potentially lead to polarization direction-dependent surface chemistry. Recent theoretical studies and advances in growing high quality epitaxial ferroelectric thin films have motivated a flurry of experimental studies aimed at creating surfaces with switchable adsorption and catalytic properties, as well as films whose polarization direction switches depending on the gas phase environment. This research news article briefly reviews the key findings of these studies. These include observations that the adsorption strengths, and in certain cases the activation energies for reactions, of polar molecules on the surfaces of ferroelectric materials are sensitive to the polarization direction. For bare ferroelectric surfaces, the magnitudes of these differences are not large, but are still comparable to the energy barrier required to switch the polarization of approximately 10 nm thick films. Highlights of a recent study where chemical switching of a thin film ferroelectric was demonstrated are presented. Attempts to use the ferroelectric polarization to influence the behavior of supported catalytic metals will also be described. It will be shown that the tendency of the metals to cluster into particles makes it difficult to alter the chemical properties of the metal surface, since it is separated from the ferroelectric by several layers of metal atoms. An alternate approach to increasing the reactivity of ferroelectric surfaces is suggested that involves modifying the surface with atoms that bind strongly to the surface and thus remain atomically dispersed.

Role of strontium in oxide epitaxy on silicon (001).

Epitaxial oxide-Si heterostructures, which integrate the functionality of crystalline oxides with Si technology, are made possible by a submonolayer of Sr deposited on Si (001). We find by electron diffraction studies using single termination Si wafers that this Sr submonolayer replaces the top layer of Si when deposited at 650 degrees C. Supported by first-principles calculations, we propose a model for the reaction dynamics of Sr on the Si surface and its effect on oxide epitaxy. This model predicts, and we experimentally confirm, an unexplored 25 degrees C pathway to crystalline oxide epitaxy on Si.

Redesigning the nursing care delivery system at Fairfax Hospital.

UNLABELLED: The redesign of the nursing delivery process at Fairfax Hospital is occurring from the top down and the bottom up. Nursing leaders have identified improvement opportunities that all units are addressing, such as reevaluating skill mix. At the same time, each inpatient nursing unit is redesigning its own processes to meet customer requirements. For example, the postpartum unit shifted to a "wellness" approach. Nurses reduced the amount of time spent in reassessing patients and are focusing instead on those things their patients are concerned about, such as teaching new mothers how to care for their babies. RESULTS: Customer research revealed that patients, physicians, and nurses wanted family-centered care from competent, caring clinicians. Flow charts identified many improvement opportunities that were common across all nursing units, such as reducing the time nurses spend reporting between shifts. Nurses are more empowered to make local decisions. Additional quantitative results are being tracked for this relatively recent effort.

Baseline and 2- to 3-year follow-up characteristics of placebo-washout responders from the nortriptyline study of depressed 6- to 12-year-olds.

Data are presented on the baseline characteristics and 2- to 3-year follow-up assessments of placebo-washout responders (PWRs) from a previously reported pharmacokinetically designed double-blind placebo-controlled trial of nortriptyline for major depressive disorder in 6- to 12-year-olds. Eleven of the 12 PWRs consented to participate in the follow-up study. At baseline, the only significant difference between the PWRs and the non-PWR subjects was that more females were PWRs. Notably, there were no significant differences with respect to severity, chronicity, age of onset, or comorbid psychopathology. The follow-up assessments showed that the rate of relapse to major depressive disorder and the rate of development of bipolarity were not significantly different for PWRs compared with non-PWRs. The authors discuss these findings vis-à-vis the adult literature and provide recommendations for the use of placebo-washout phases in future double-blind, placebo-controlled psychopharmacology trials in children.