Glycemic control in a medical intensive care setting: revision of an intensive care unit nurse-driven hyperglycemia protocol.

The purpose of this study was to determine whether the addition of rapid-acting insulin bolus for enteral feed coverage and a reduction in basal insulin improve glycemic control and decrease hypoglycemia in a medical intensive care unit. A quasi-experimental posttest design assessing glucose control postimplementation of a revised nurse-driven ICU hyperglycemia protocol was conducted on a 16-bed medical intensive care unit at a multicenter hospital system. A daily report of all patients on the ICU hyperglycemia protocol was automated for the inpatient diabetes management team, and pertinent data were collected. Univariate statistics were conducted for all variables. The variability in blood glucose based on different clinical variables was compared using t tests. The hypoglycemic rate was only 0.72%, and no glucose value was less than 40 mg/dL. In addition, the mean glucose value throughout the study was 160.9 ± 35.6 mg/dL. Findings from this study will hopefully provide insight on an effective way to control glucose within a medical intensive care unit as well as reduce hypoglycemia rates within this setting.

Rinderpest virus expressing enhanced green fluorescent protein as a separate transcription unit retains pathogenicity for cattle.

A full-length DNA clone of a virulent strain of rinderpest virus was constructed with the gene for the enhanced green fluorescent protein (eGFP) inserted as a separate transcription unit between the P and M genes. Rescue of the virus from the modified clone using reverse genetics generated a virus that grew to the same levels as the virus rescued from the unmodified DNA clone in cell culture. The recombinant virus expressed eGFP to a high level and was used to follow virus replication in real-time using live-cell imaging. Cattle infected with both the recombinant wild-type virus and the recombinant eGFP expressing virus developed clinical disease similar to that of the wild-type natural virus isolate. Detection of virus in circulating peripheral blood leukocytes was equivalent to that of the animals infected with the wild-type virus. The high level of expression of soluble eGFP by this virus allowed us to detect viral replication in infected animals by confocal microscopy. Imaging vibrating microtome sections by confocal microscopy provided good preservation of tissue and cellular architecture as well as revealing the sites of replication of the virus in different tissues of infected animals.

Why New Zealand must rapidly halve its greenhouse gas emissions.

New Zealand must commit to substantial decreases in its greenhouse gas emissions, to avoid the worst impacts of climate change on human health, both here and internationally. We have the fourth highest per capita greenhouse gas emissions in the developed world. Based on the need to limit warming to 2 degrees C by 2100, our cumulative emissions, and our capability to mitigate, New Zealand should at least halve its greenhouse gas emissions by 2020 (i.e. a target of at least 40% less than 1990 levels). This target has a strong scientific basis, and if anything may be too lenient; reducing the risk of catastrophic climate change may require deeper cuts. Short-term economic costs of mitigation have been widely overstated in public debate. They must also be balanced by the far greater costs caused by inertia and the substantial health and social benefits that can be achieved by a low emissions society. Large emissions reductions are achievable if we mobilise New Zealand society and let technology follow the signal of a responsible target.