Procedure for the identification of population characteristics for targeting intervention services on the basis of outcome-goal priorities: Case management services for the chronic mentally ill

Although the processes involved in rational patient targeting may be obvious for certain services, for others, both the appropriate sub-populations to receive services and the procedures to be used for their identification may be unclear. This project was designed to address several research questions which arise in the attempt to deliver appropriate services to specific populations. The related difficulties are particularly evident for those interventions about which findings regarding effectiveness are conflicting. When an intervention clearly is not beneficial (or is dangerous) to a large, diverse population, consensus regarding withholding the intervention from dissemination can easily be reached. When findings are ambiguous, however, conclusions may be impossible.^ When characteristics of patients likely to benefit from an intervention are not obvious, and when the intervention is not significantly invasive or dangerous, the strategy proposed herein may be used to identify specific characteristics of sub-populations which may benefit from the intervention. The identification of these populations may be used both in further informing decisions regarding distribution of the intervention and for purposes of planning implementation of the intervention by identifying specific target populations for service delivery.^ This project explores a method for identifying such sub-populations through the use of related datasets generated from clinical trials conducted to test the effectiveness of an intervention. The method is specified in detail and tested using the example intervention of case management for outpatient treatment of populations with chronic mental illness. These analyses were applied in order to identify any characteristics which distinguish specific sub-populations who are more likely to benefit from case management service, despite conflicting findings regarding its effectiveness for the aggregate population, as reported in the body of related research. However, in addition to a limited set of characteristics associated with benefit, the findings generated, a larger set of characteristics of patients likely to experience greater improvement without intervention. ^

Biomarker circadian rhythm profiles in critically ill mechanically ventilated patients

Objective: To explore the natural trajectory of core body temperature (CBT) and cortisol (CORT) circadian rhythms in mechanically ventilated intensive care unit (MV ICU) patients. ^ Design: Prospective, observational, time-series pilot study. ^ Setting: Medical-surgical and pulmonary ICUs in a tertiary care hospital. ^ Sample: Nine (F = 3, M = 6) adults who were mechanically ventilated within 12 hrs of ICU admission with mean ± SD age of 65.2 ± 14 years old. ^ Measurements: Core body temperature and environmental measures of light, sound, temperature, and relative humidity were logged in 1-min intervals. Hourly urine specimens and 2-hr interval blood specimens were collected for up to 7 consecutive days for CORT assay. Mechanical ventilation days, ICU length of stay, and ICU mortality were documented. Acute Physiology and Chronic Health Evaluation (APACHE) II scores were computed for each study day. The data of each biologic and environmental variable were analyzed using single cosinor analysis of 24-hr serial segments. One patient did not complete the study because mortality occurred within 8 hrs of enrollment. Nine ICU patients completed the study in 1.6 to 7.0 days. ^ Results: No normal circadian rhythm pattern was found when the cosinor-derived parameters of amplitude (one-half the peak-trough variability) and acrophase (peak time) were compared with cosinor-derived parameter reference ranges of healthy, diurnally active humans, although 83% of patient-day CBT segments showed statistically significant (p ≤ .05) and biologically meaningful (R2≥ 0.30) 24-hr rhythms with abnormal cosinor parameters. Cosinor parameters of the environmental temporal profiles showed 27% of light, 76% of ambient temperature, and 78% of relative humidity serial segments had a significant and meaningful 24-hr diurnal pattern. Average daily light intensity varied from 34 to 187 lx with a maximum light exposure of 1877 lx. No sound measurement segment had a statistically significant cosine pattern, and numerous 1-minute interval peaks ≥ 60 dB occurred around the clock. Average daily ambient temperature and relative humidity varied from 19 to 24°C and from 25% to 61%, respectively. There was no statistically significant association between CBT or clinical outcomes and cosinor-derived parameters of the environmental variables. Circadian rhythms of urine and plasma CORT were deferred for later analysis. ^ Conclusions: The natural trajectory of the CBT circadian rhythm in MV ICU patients demonstrated persistent cosinor parameter alteration, even when a significant and meaningful 24-hr rhythm was present. The ICU environmental measures showed erratic light and sound exposures. Room temperature and relative humidity data produced the highest rate of significant and meaningful diurnal 24-hr patterns. Additional research is needed to clarify relations among the CBT biomarker of the circadian clock and environmental variables of MV ICU patients. ^

Clay mineralogy of sediments from the Bengal Fan

We have measured the relative abundances of smectite, illite, chlorite, and kaolinite in a composite section of the distal Bengal Fan. Two sources of sediment appear to dominate, a smectite-poor, illite-rich source associated with rapid denudation of the Himalayas and a smectite-rich, illite-poor source probably on the continental margin of the Indian sub-continent. Changes in source appear to be related to uplift in the Himalayas and Tibetan Plateau both directly and through the climatic and oceanographic consequences of uplift.

Cristauaren bicitza, edo bicitza berria eguiteco videa, eta ondo illtzen icasteco, ta ondo illtzen laguntzeco ejercicioac / animen provechuraco confesore jaun celosoai, eta ondo ill nai dutenai, ta ondo illtzen lagundu nai duten Jaincoaren ministroai, Agustin Cardaberazec esqueintzen ta dedicatzen diztenac

Dialecto : texto en euskera central -- guipuzcoano

Mayetzeco ill edo Birgina chit santari consagratutaco mayetzeco ill : cristau fededunac beren ama maiteari lora sorta ederrac becela esqueñi lizaizquioten cembait birtutezco lanequin batera, Jesusen compañiaco colegio nagusian len eguiñ oy zan ... / Greg

Autor: Ramón García; tomado de: Sommervogel. v. III, col. 1221

RETRATO DEL EX.MO É ILL.MO S.OR D.N FRAI JOAQUIN COMPANY [Material gráfico] : Caballero Gran Cruz de la Rl. distinguida Orden de Carlos III Arzobispo antes de Zaragoza y después de Valencia

Resumen: Descripción: retrato de 3/4 en el interior de un óvalo. Viste indumentaria de arzobispo. En el ángulo izqdo., la mitra y báculo

The H5 guide system - the latest innovative guide system at the ILL

The H5 program with the complete rebuild of the guide system and the upgrade or renovation of all instruments leads to a tremendous increase of the instrument performances. The improvement was obtained both in terms of more useful flux and upgrade of the different instruments (e.g. higher field density for IN15). In addition, the industrial application instrument D50 offers an addition to the ILL instrument suite (see p. 27 in this issue). With the commissioning of the new spin echo spectrometer WASP in 2016, the H5 program will be completed and a considerable improvement for the ILL instrument park will be finalized.

Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials

Objective: To determine the effect on mortality of resuscitation with colloid solutions compared with resuscitation with crystalloids.

Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials

Objective: To determine whether antibiotic prophylaxis reduces respiratory tract infections and overall mortality in unselected critically ill adult patients.

Human albumin administration in critically ill patients: systematic review of randomised controlled trials

Objective: To quantify effect on mortality of administering human albumin or plasma protein fraction during management of critically ill patients.