Prediction of Patient Length of Stay on the Intensive Care Unit Following Cardiac Surgery: A Logistic Regression Analysis Based on the Cardiac Operative Mortality Risk Calculator, EuroSCORE.

OBJECTIVE: The aim of this study was to develop a statistical model based on patient parameters to predict the length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery in a single center. DESIGN: Data were collected from patients admitted to the ICU following cardiac surgery over a 10-year period (2006-2016). Both the additive and logistic EuroSCORE were calculated, and logistic regression analysis was carried out to formulate a model relating the predicted LOS to the EuroSCORE. This model was used to stratify patients into short stay (less than 48 hours) or long stay (more than 48 hours). SETTING: ICU at Papworth Hospital, Cambridgeshire. PARTICIPANTS: A total of 18,377 consecutive patients who had been in ICU following cardiac surgery (coronary graft bypass surgery, valve surgery, or a combination of both). INTERVENTIONS: This was an observational study. MEASUREMENTS AND MAIN RESULTS: The authors have shown that both the additive and logistic EuroSCORE can be used to stratify cardiac surgical patients in various predicted LOS in ICU. Further adjustments can be made to increase the number of patients correctly identified as either short stay or long stay. Comparison of the model predictions to the data demonstrated a high overall accuracy of 79.77%, and receiver operating characteristic curve analysis showed the area under the curve to be 0.7296. CONCLUSION: This analysis of an extensive data set shows that patient LOS in ICU after cardiac surgery in a single center can be predicted accurately using the simple cardiac operative risk scoring tool EuroSCORE. Using such predictions has the potential to improve ICU resource management.

Mapping nanoscale electrochemistry of individual single-walled carbon nanotubes.

We introduce a multiprobe platform for the investigation of single-walled carbon nanotubes (SWNTs) that allows the electrochemical response of an individual SWNT to be mapped at high spatial resolution and correlated directly with the intrinsic electronic and structural properties. With this approach, we develop a detailed picture of the factors controlling electrochemistry at SWNTs and propose a definitive model that has major implications for future architectures of SWNT electrode devices.

A new approach for the fabrication of microscale lipid bilayers at glass pipets: application to quantitative passive permeation visualization.

A new method of planar bilayer lipid membrane (BLM) formation is presented that allows stable, solvent-free lipid bilayers exhibiting high seal resistances to be formed rapidly, easily and reproducibly. Using these bilayers the passive permeation of a series of carboxylic acids is investigated, to determine quantitatively the trend in permeability with lipophilicity of the acid. BLMs are formed at the tip openings of pulled theta pipets, and the rate of permeation of each carboxylic acid across the bilayer, from within the pipet into the bulk solution is determined. This is achieved through spatially-resolved measurements of the pH change that occurs upon the permeation of the weak acid, visualized using a pH-sensitive fluorophore with a confocal laser scanning microscope. The extracted fluorescence profiles are matched to finite element method (FEM) simulations, to allow the associated permeation coefficient for each weak acid to be determined with high accuracy, since this is the only adjustable parameter used to fit the experimental data. For bilayers formed in this way, the weak acids show increasing permeability with lipophilicity. Furthermore, the arrangement allows the effect of a trans-membrane electric field on permeation to be explored. For both propanoic and hexanoic acid it is found that an applied electric field enhances molecular transport, which is attributed to the formation of pores within the membrane.

High resolution mapping of oxygen reduction reaction kinetics at polycrystalline platinum electrodes.

The scanning droplet-based technique, scanning electrochemical cell microscopy (SECCM), combined with electron backscatter diffraction (EBSD), is demonstrated as a powerful approach for visualizing surface structure effects on the rate of the oxygen reduction reaction (ORR) at polycrystalline platinum electrodes. Elucidating the effect of electrode structure on the ORR is of major interest in connection to electrocatalysis for energy-related applications. The attributes of the approach herein stem from: (i) the ease with which the polycrystalline substrate electrode can be prepared; (ii) the wide range of surface character open to study; (iii) the possibility of mapping reactivity within a particular facet (or grain), in a pseudo-single-crystal approach, and acquiring a high volume of data as a consequence; (iv) the ready ability to measure the activity at grain boundaries; and (v) an experimental arrangement (SECCM) that mimics the three-phase boundary in low temperature fuel cells. The kinetics of the ORR was analyzed and a finite element method model was developed to explore the effect of the three-phase boundary, in particular to examine pH variations in the droplet and the differential transport rates of the reactants and products. We have found a significant variation of activity across the platinum substrate, inherently linked to the crystallographic orientation, but do not detect any enhanced activity at grain boundaries. Grains with (111) and (100) contributions exhibit considerably higher activity than those with (110) and (100) contributions. These results, which can be explained by reference to previous single-crystal measurements, enhance our understanding of ORR structure-activity relationships on complex high-index platinum surfaces, and further demonstrate the power of high resolution flux imaging techniques to visualize and understand complex electrocatalyst materials.

Evaluation of the Role of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic via a Collaborative Drug Therapy Management Protocol.

Historically, pharmacists have not been formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The objective of this study was to evaluate the number and type of medication-related interventions made by a clinical pharmacist, in an adult burn clinic, via a CDTM protocol. The protocol allows pharmacists to independently manage the following disease states: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All pharmacist visits between 1/1/22 and 9/22/22 were included. A total of 16 patients were seen at 28 visits with a clinical pharmacist for a total of 148 interventions. Patients were mostly males (81%) with a mean ± SD age of 41 ± 15 years. The majority of patients were in-state (94%), with 9 (56%) being from an outlying county. Patients were seen for a median (IQR) of 2 (1,2) visits. Interventions were made at all visits (100%) with a median of 5 (4,6) per visit. Interventions (per visit) included medication reconciliation [28 (100%)], a median of 1 (0,2) medication ordered or adjusted, labs ordered at 7 (25%) visits, with adherence and patient education both reviewed at over 90% of visits. To the best of our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, with a pharmacist directly impacting transitions of care. This may serve as a framework for other sites. Future directions include continuing to track data for medication adherence and access, billing/reimbursement, and clinical outcomes.

Electrochemical mapping reveals direct correlation between heterogeneous electron-transfer kinetics and local density of states in diamond electrodes.

Conducting carbon materials: a multi-microscopy approach shows that local heterogeneous electron-transfer rates at conducting diamond electrodes correlate with the local density of electronic states. This model of electroactivity is of considerable value for the rational design of conducting diamond electrochemical technologies, and also provides key general insights on electrode structure controls in electrochemical kinetics.

Trace voltammetric detection of serotonin at carbon electrodes: comparison of glassy carbon, boron doped diamond and carbon nanotube network electrodes.

The characteristics of three different carbon electrodes, glassy carbon (GC), oxygen-terminated polycrystalline boron-doped diamond (pBDD) and "pristine" carbon nanotube networks (CNTN) as voltammetric sensors for detection of the neurotransmitter serotonin have been investigated. For each electrode, detection sensitivity was determined using cyclic voltammetry (CV), a technique often used to provide information on chemical identity in electrochemical assays. The CNTN electrodes were found to exhibit background current densities ca. two orders of magnitude smaller than the GC electrode and ca. twenty times smaller than pBDD, as a consequence of their "pristine" low capacitance and low surface coverage. This was a major factor in determining serotonin detection limits from CV, of 10 nM for the CNTN electrode, 500 nM for pBDD and 2 microM for GC. The two most sensitive electrodes (CNTN and pBDD) were further investigated in terms of resistance to electrode fouling. CV analysis showed that fouling was less on the pBDD electrode compared to the CNTN and, furthermore, for the case of pBDD could be significantly minimised by careful selection of the CV potential limits, in particular by scanning the electrode potential to suitably cathodic values after oxidation of the serotonin.

Selection, characterisation and mapping of complex electrochemical processes at individual single-walled carbon nanotubes: the case of serotonin oxidation.

The electrochemical (EC) oxidation of the neurotransmitter, serotonin, at individual single-walled carbon nanotubes (SWNTs) is investigated at high resolution using a novel platform that combines flow-aligned SWNTs with atomic force microscopy, Raman microscopy, electronic conductance measurements, individual SWNT electrochemistry and high-resolution scanning electrochemical cell microscopy (SECCM). SECCM has been used to visualise the EC activity along side-wall sections of metallic SWNTs to assess the extent to which side-walls promote the electrochemistry of this complex multi-step process. Uniform and high EC activity is observed that is consistent with significant reaction at the side-wall, rather than electrochemistry being driven by defects alone. By scanning forward and reverse (trace and retrace) over the same region of a SWNT, it is also possible to assess any blocking of EC activity by serotonin oxidation reaction products. At a physiologically relevant concentration (5 µM), there is no detectable blocking of SWNTs, which can be attributed, at least in part, to the high diffusion rate to an individual, isolated SWNT in the SECCM format. At higher serotonin concentration (2 mM), oligomer formation from oxidation products is much more significant and major blocking of the EC process is observed from line profiles recorded as the SECCM meniscus moves over an SWNT. The SECCM line profile morphology is shown to be highly diagnostic of whether blocking occurs during EC processes. The studies herein add to a growing body of evidence that various EC processes at SWNTs, from simple outer sphere redox reactions to complex multi-step processes, occur readily at pristine SWNTs. The platform described is of general applicability to various types of nanostructures and nanowires.

Treatment of incarcerated, sexually-abused adolescent females: an outcome study.

This study examined the psychosocial functioning of 100 adolescent females (ages 12-17) sentenced to secure care in a southeastern state and the impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of subjects who reported a history of sexual abuse. The Multidimensional Adolescent Assessment Scale (MAAS) was used to assess psychosocial functioning. Pre-test scores on the MAAS revealed significantly higher scores on 12 of 16 dimensions of psychosocial functioning and higher rates of serious criminal behavior for youth who subsequently disclosed sexual abuse histories as compared to those without such histories. At post-test, statistically significant improvements in psychosocial functioning were observed on 14 of 16 MAAS subscales for those who received the CBT intervention. Thus, incarcerated female adolescents who reported a history of sexual abuse demonstrated more impairment in their functioning as compared to those without a reported history of sexual abuse and responded positively to gender-specific, CBT-based intervention.