A prospective study of remote delirium screening using the modified K-4AT for COVID-19 inpatients.

Background: Delirium is a neuropsychiatric condition strongly associated with poor clinical outcomes such as high mortality and long hospitalization. In the patients with Coronavirus disease 2019 (COVID-19), delirium is common and it is considered as one of the risk factors for mortality. For those admitted to negative-pressure isolation units, a reliable, validated and contact-free delirium screening tool is required. Materials and methods: We prospectively recruited eligible patients from multiple medical centers in South Korea. Delirium was evaluated using the Confusion Assessment Method (CAM) and 4'A's Test (4AT). The attentional component of the 4AT was modified such that respondents are required to count days, rather than months, backward in Korean. Blinded medical staff evaluated all patients and determined whether their symptoms met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). An independent population of COVID-19 patients was used to validate the 4AT as a remote delirium screening tool. We calculated the area under the receiver operating characteristic curve (AUC). Results: Out of 286 general inpatients, 28 (9.8%) inpatients had delirium. In this population, the patients with delirium were significantly older (p = 0.018) than the patients without delirium, and higher proportion of males were included in the delirium group (p < 0.001). The AUC of the 4AT was 0.992 [95% confidence interval (CI) 0.983-1.000] and the optimal cutoff was at 3. Of the independent COVID-19 patients, 13 of 108 (12.0%) had delirium. Demographically, the COVID-19 patients who had delirium only differed in employment status (p = 0.047) from the COVID-19 patients who did not have delirium. The AUC for remote screening using the 4AT was 0.996 (0.989-1.000). The optimal cutoff of this population was also at 3. Conclusion: The modified K-4AT had acceptable reliability and validity when used to screen inpatients for delirium. More importantly, the 4AT efficiently screened for delirium during remote evaluations of COVID-19 patients, and the optimal cutoff was 3. The protocol presented herein can be used for remote screening of delirium using the 4AT.

Comprehensive analysis of microbial dynamics linked with the reduction of odorous compounds in a full-scale swine manure pit recharge system with recirculation of aerobically treated liquid fertilizer.

It is believed that the generation of odorous materials in manure-slurry pits during the storage can be reduced by recirculating aerobically treated liquid fertilizer (ATLF) to a manure-pit recharge system (PRS). However, the biological mechanisms for reduction of those problematic compounds remain poorly understood. In this study, the links between microbial evolution and changes in chemical composition and odorous compounds were analyzed where swine-manure slurry was stored in a full-scale PRS. Some beneficial microorganisms were successfully established in the PRS. This resulted in the accumulation of fewer undesirable chemical components and lower amounts of odorous compounds compared to those in a conventional swine-manure slurry pit (the control). Decrease in the volatile fatty acids (1387-8478 mg/L â†’ 306-1258 mg/L) and NH3 (3387-4300 mg/L â†’ 85-200 mg/L) in the PRS was mainly due to the development of a key community that included a mix of aerobic, anaerobic fermentative, nitrifying (0.1-0.6%) and denitrifying (1.7-3.5%), and methanogenic microorganisms (2.1-4.2%). Meanwhile, the generation of greater amounts of H2S (12-290 mg/L â†’ 61-1754 mg/L) was found in the PRS, which condition was supported by the increased proportion of sulfate-reducing bacteria (0.5-3%). To the authors' best knowledge this is the first study comprehensively analyzing microbial dynamics linked with the reduction of odorous compounds in the full-scale PRS in response to recirculation of ATLF.

Compositional and Functional Characteristics of Swine Slurry Microbes through 16S rRNA Metagenomic Sequencing Approach.

Traditionally slurry is used as source of nitrogen, phosphorous, and potassium in bio fertilizers to improve crop production. However, poorly managed slurry causes a hazardous effect to the environment by producing greenhouse gases, causing the eutrophication of water bodies, and polluting the groundwater. It has been largely reported that the microbial presence in slurry causing a diverse effect on its storage and disposal system. However, the diversity of bacterial populations in pig slurries remains largely unexplored. Here we report the bacterial diversity present in the slurry from slurry pits, and the effect of storage time on bacterial population. We collected 42 samples from three different pig slurry pits, as three replicates from each one until the 14th week. We used the 16S rRNA, Quantitative Insights Into Microbial Ecology (QIIME) and Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) protocols for the metagenomic downstream analysis. Taxonomic annotation using the Greengenes metagenomic database indicated that on an average 76.2% Firmicutes, 14.4% Bacteroidetes, 4.9% Proteobacteria, etc. microbial populations were present. Comparative microbial analysis showed that the population of Firmicutes decreased from the first to the 14th week, whereas the population of Bacteroidetes increased from the first to the 14th week. Through principal coordinate analysis (PCoA), (linear discriminant analysis effect size (LEfSe), and Pearson's correlation analysis, we found microbial biomarkers according to the storage time point. All bacterial populations were well clustered according to the early, middle, and last weeks of storage. LEfSe showed that Actinobacteria, Lachnospiraceae, Ruminococcaceae, and Bacteroidia are dominantly present in first, seventh, ninth, and 14th week, respectively. Lachnospiraceae and Ruminococcaceae are ubiquitous gastrointestinal non-pathogenic bacteria. KEGG pathways, such as membrane transport, carbohydrate and amino acid metabolism, genetic replication and repair, were significant among all samples. Such a KEGG pathway may indicate the association between the host organism's metabolic activity and the microbes present in the gastro intestinal tract (GIT).

Catalytic pyrolysis of swine manure using CO2 and steel slag.

Pyrolysis of swine manure (SM) was conducted as a case study to establish an environmentally sound management of livestock manure. To build a more renewable pyrolysis platform for SM, this study selected carbon dioxide (CO2) as the reaction medium. In addition, CO2 was used in pyrolysis of SM to restrict the formation of toxic compounds, such as benzene derivatives and polycyclic aromatic hydrocarbons (PAHs). A series of thermo-gravimetric analysis (TGA) tests was done to understand the thermolysis of SM in the CO2 environment. The TGA tests elucidated no occurrence of heterogeneous reactions between the SM sample and the CO2. Moreover, the TGA tests of SM suggested that SM contains more volatile matter (VM) than lignocellulosic biomass. Non-catalytic transesterification of SM lipids confirmed that the dried SM sample contained 8.85 ±â€¯0.05 wt% of lipids. This study also confirmed that the mechanistic role of CO2 was realized through the gas phase reactions between volatile pyrolysates evolved from the thermolysis of SM and CO2. In summary, CO2 donates O, enhancing the generation of CO through homogeneous reactions. In parallel, this study confirmed that CO2 suppress dehydrogenation. Therefore, the identified gas phase reactions between volatile pyrolysates and CO2 led to the compositional modifications in the condensable pyrolysates. However, such mechanistic features arising from CO2 only initiated at ≥520 °C. To expedite the reaction kinetics of the homogeneous reaction triggered by CO2, steel slag (SS) was used as a catalyst. Hence, the reaction kinetics associated with the mechanistic role of CO2 were substantially enhanced (up to 80%) when SS was used as a catalyst. Therefore, all experimental findings strongly suggest that CO2 can be utilized as a raw material in a thermo-chemical process. More importantly, all observations suggest that CO2 lopping can also be achieved in a thermo-chemical process. Lastly, this study shows that the high Cu content in SM was effectively immobilized through pyrolysis. Conclusively, this study experimentally proved that CO2 could be promising for restricting the formation of toxic pollutant in the thermo-chemical treatment in that CO2 offers an innovative and strategic means for controlling the ratio of C to H. Note that aromaticity and toxicity of chemical compounds are highly contingent on the ratio of C to H.

Biochemical Changes and Biological Origin of Key Odor Compound Generations in Pig Slurry during Indoor Storage Periods: A Pyrosequencing Approach.

Production of odors is a complex process. Many bacterial species are involved in the production of an extensive array of key odor compounds in stored pig slurry. Understanding of basic microbial communities and their role during storage periods is an essential way to control and prevent the odors generations. In this aspect, the pig slurry samples were taken directly from deep pits of finisher pig building every two weeks, their biochemical changes were analysed, and the indigenous bacterial communities that involve in offensive odor producing compounds were identified. The SCFA, BCFA, phenols, and indoles levels altered drastically in the slurry during storage periods. The COD, BOD, SS, P2O5, TKN, and NH4-N were increased in the stored slurry. Bacterial ecology indicates Firmicutes and Bacteroidetes phyla were dominantly found in pig slurry. Odorants produced in pig slurry were correlated with bacterial communities. Phenols, indoles, SCFA, and BCFA productions were positively correlated with bacteria species which comes under phyla of Firmicutes and Bacteroidetes. It seems that bacterial species under Firmicutes and Bacteroidetes phyla play an important role in the offensive odor compounds production. Taken together, the prevention of these phyla bacterial growth and early discharge of pig slurry might reduce the offensive odor production.

Comparison of gradient-recalled echo and spin-echo echo-planar imaging MR elastography in staging liver fibrosis: a meta-analysis.

OBJECTIVES: To compare the diagnostic performance of gradient-recalled echo-based magnetic resonance elastography (GRE-MRE) and spin-echo echo-planar imaging-based MRE (SE-EPI-MRE) in liver fibrosis staging. METHODS: A systematic literature search was performed to identify studies involving the performance of MRE for the diagnosis of liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, the diagnostic odds ratio, and a summary receiver operating characteristic (ROC) curve were estimated by using a bivariate random effects model. Subgroup analyses were performed between different study characteristics. RESULTS: Twenty-six studies with a total of 3,200 patients were included in the meta-analysis. Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE did not differ significantly. The area under the summary ROC curve for stage diagnosis of any (F ≥ 1), significant (F ≥ 2), advanced (F ≥ 3), and cirrhosis (F = 4) on GRE-MRE and SE-EPI-MRE were 0.93 versus 0.94, 0.95 versus 0.94, 0.94 versus 0.95, and 0.92 versus 0.93, respectively. Substantial heterogeneity was detected for both sequences. CONCLUSION: Both GRE and SE-EPI-MRE show high sensitivity and specificity for detection of each stage of liver fibrosis, without significant differences. Magnetic resonance elastography (MRE) may be useful for noninvasive evaluation of liver fibrosis in chronic liver disease. KEY POINTS: • Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE did not differ significantly. • GRE-MRE and SE-EPI-MRE were highly accurate for detecting all stages of fibrosis. • Due to better agreement and repeatability, GRE-MRE should be used first. • In case of failure on GRE-MRE, SE-EPI-MRE should be used.

Clinical characteristics and treatment propensity in elderly patients aged over 80 years with colorectal cancer.

BACKGROUND/AIMS: Elderly patients (≥ 80 years) with colorectal cancer (CRC) tend to avoid active treatment at the time of diagnosis despite of recent advances in treatment. The aim of this study was to determine treatment propensity of elderly patients aged ≥ 80 years with CRC in clinical practice and the impact of anticancer treatment on overall survival (OS). METHODS: Medical charts of 152 elderly patients (aged ≥ 80 years) diagnosed with CRC between 1998 and 2012 were retrospectively reviewed. Patients' clinical characteristics, treatment modalities received, and clinical outcome were analyzed. RESULTS: Their median age was 82 years (range, 80 to 98). Of 152 patients, 148 were assessable for the extent of the disease. Eighty-two of 98 patients with localized disease and 28 of 50 patients with metastatic disease had received surgery or chemotherapy or both. Surgery was performed in 79 of 98 patients with localized disease and 15 of 50 patients with metastatic disease. Chemotherapy was administered in only 24 of 50 patients with metastatic disease. Patients who received anticancer treatment according to disease extent showed significantly longer OS compared to untreated patients (localized disease, 76.2 months vs. 15.4 months, p = 0.000; metastatic disease, 9.9 months vs. 2.6 months, p = 0.001). Along with anticancer treatment, favorable performance status (PS) was associated with longer OS in multivariate analysis of clinical outcome. CONCLUSION: Elderly patients aged ≥ 80 years with CRC tended to receive less treatment for metastatic disease. Nevertheless, anticancer treatment in patients with favorable PS was effective in prolonging OS regardless of disease extent.

Primary Sternal Osteomyelitis caused by Staphylococcus aureus in an Immunocompetent Adult.

Primary sternal osteomyelitis (PSO) is a rare condition that may develop without any contiguous focus of infection. Due to the rarity of the disease, early diagnosis and appropriate treatment are often delayed. Herein, we describe a patient with PSO caused by Staphylococcus aureus that presented with chest pain and fever. The patient had no predisposing factors for sternal osteomyelitis. The chest pain was thought to be non-cardiogenic, as electrocardiography and cardiac enzyme did not reveal ischemic changes when he visited the emergency room. After blood culture revealed the presence of S. aureus, every effort was made to identify the primary focus of infection. Bone scan and magnetic resonance imaging revealed osteomyelitis with soft tissue inflammation around the sternum. After 8 weeks of antibiotics treatment, the patient recovered without any complications.