Lateral positioning for critically ill adult patients

BACKGROUND: Critically ill patients require regular body position changes to minimize the adverse effects of bed rest, inactivity and immobilization. However, uncertainty surrounds the effectiveness of lateral positioning for improving pulmonary gas exchange, aiding drainage of tracheobronchial secretions and preventing morbidity. In addition, it is unclear whether the perceived risk levied by respiratory and haemodynamic instability upon turning critically ill patients outweighs the respiratory benefits of side-to-side rotation. Thus, lack of certainty may contribute to variation in positioning practice and equivocal patient outcomes. OBJECTIVES: To evaluate effects of the lateral position compared with other body positions on patient outcomes (mortality, morbidity and clinical adverse events) in critically ill adult patients. (Clinical adverse events include hypoxaemia, hypotension, low oxygen delivery and global indicators of impaired tissue oxygenation.) We examined single use of the lateral position (i.e. on the right or left side) and repeat use of the lateral position (i.e. lateral positioning) within a positioning schedule. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1950 to 23 May 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to 23 May 2015), the Allied and Complementary Medicine Database (AMED) (1984 to 23 May 2015), Latin American Caribbean Health Sciences Literature (LILACS) (1901 to 23 May 2015), Web of Science (1945 to 23 May 2015), Index to Theses in Great Britain and Ireland (1950 to 23 May 2015), Trove (2009 to 23 May 2015; previously Australasian Digital Theses Program (1997 to December 2008)) and Proquest Dissertations and Theses (2009 to 23 May 2015; previously Proquest Digital Dissertations (1980 to 23 May 2015)). We handsearched the reference lists of potentially relevant reports and two nursing journals. SELECTION CRITERIA: We included randomized and quasi-randomized trials examining effects of lateral positioning in critically ill adults. We included manual or automated turns but limited eligibility to studies that included duration of body position of 10 minutes or longer. We examined each lateral position versus at least one comparator (opposite lateral position and/or another body position) for single therapy effects, and the lateral positioning schedule (repeated lateral turning) versus other positioning schedules for repetitive therapy effects. DATA COLLECTION AND ANALYSIS: We pre-specified methods to be used for data collection, risk of bias assessment and analysis. Two independent review authors carried out each stage of selection and data extraction and settled differences in opinion by consensus, or by third party adjudication when disagreements remained unresolved. We planned analysis of pair-wise comparisons under composite time intervals with the aim of considering recommendations based on meta-analyses of studies with low risk of bias. MAIN RESULTS: We included 24 studies of critically ill adults. No study reported mortality as an outcome of interest. Two randomized controlled trials (RCTs) examined lateral positioning for pulmonary morbidity outcomes but provided insufficient information for meta-analysis. A total of 22 randomized trials examined effects of lateral positioning (four parallel-group and 18 cross-over designs) by measuring various continuous data outcomes commonly used to detect adverse cardiopulmonary events within critical care areas. However, parallel-group studies were not comparable, and cross-over studies provided limited data as the result of unit of analysis errors. Eight studies provided some data; most of these were single studies with small effects that were imprecise. We pooled partial pressure of arterial oxygen (PaO2) as a measure to detect hypoxaemia from two small studies of participants with unilateral lung disease (n = 19). The mean difference (MD) between lateral positions (bad lung down versus good lung down) was approximately 50 mmHg (MD -49.26 mmHg, 95% confidence interval (CI) -67.33 to -31.18; P value < 0.00001). Despite a lower mean PaO2 for bad lung down, hypoxaemia (mean PaO2 < 60 mmHg) was not consistently reported. Furthermore, pooled data had methodological shortcomings with unclear risk of bias. We had similar doubts regarding internal validity for other studies included in the review. AUTHORS' CONCLUSIONS: Review authors could provide no clinical practice recommendations based on the findings of included studies. Available research could not eliminate the uncertainty surrounding benefits and/or risks associated with lateral positioning of critically ill adult patients. Research gaps include the effectiveness of lateral positioning compared with semi recumbent positioning for mechanically ventilated patients, lateral positioning compared with prone positioning for acute respiratory distress syndrome (ARDS) and less frequent changes in body position. We recommend that future research be undertaken to address whether the routine practice of repositioning patients on their side benefits all, some or few critically ill patients.

Controllable graphene oxide mediated efficient electron transfer pathways across self-assembly monolayers: a new class of graphene based electrodes

In this paper, the influence of chemically reduced graphene oxide sheets (CRGOs) on the electrochemical performance through methyl or carboxylic acid terminated self-assembled monolayers (SAMs) is reported. The gold electrode was initially modified with methyl or carboxylic acid terminated alkanethiols with various carbon chain lengths (n = 4, 6, 8 and 11) and subsequently immobilization of the CRGOs on a SAM surface was achieved via a hydrophobic and electrostatic interaction. By using the potassium ferricyanide as a redox probe, it was observed that CRGOs could effectively enhance the heterogeneous electron transfer (ET) of the SAM due to a tunneling effect. The assemblies based on thiol end groups with methyl head groups were observed to afford more hydrophobic interaction binding with CRGOs with a higher reduction time than the assemblies developed with thiol end groups and a -COOH group which were shown to bind more electrostatically with CRGOs, a lowering reduction time. The Nyquist plots developed show a gradual decrease of the charge transfer resistance (Rct) of [Fe(CN)6]3-/4- redox couple at the CRGOs-SAMs electrode with the controllable adsorption of different CRGO's onto the SAM. Depending on the chain length and terminal functional group the electron transfer rate kinetics were observed to differ considerably.

Preparation of an Immunosorbent and its use in the Solid Phase Extraction of Benzodiazepines

The use of capillary electrophoresis (CE) has been restricted to applications having high sample concentrations because of its low sensitivity caused by small injection volumes and, when ultraviolet (UV) detection is used, the short optical path length. Sensitivity in CE can be improved by using more sensitive detection systems, or by preconcentration techniques which are based on chromatographic and/or electrophoretic principles. One of the promising strategies to improve sensitivity is solid phase extraction (SPE). Solid Phase Extraction utilizes high sample volumes and a variety of complex matrixes to facilitate trace detection. To increase the specificity of the SPE a selective solid phase must be chosen. Immunosorbents, which are a combination of an antibody and a solid support, have proven to be an excellent option because of high selectivity of the antibody. This thesis is an exploratory study of the application of immunosorbent-SPE combined with CE for trace concentration of benzodiazepines. This research describes the immobilization and performance evaluation of an immunosorbent prepared by immobilizing a benzodiazepine-specific antibody on aminopropyl silica. The binding capacity of the immunosorbent, measured as µg of benzodiazepine/ gram of immunosorbent, was 39 ± 10. The long term stability of the prepared immunosorbent has been improved by capping the remaining aminopropyl groups by reaction with acetic anhydride. The capped immunosorbent retained its binding capacity after several uses.

Label-free oligonucleotide biosensor based on dual-peak long period fiber grating

We report the simplification and development of biofunctionalization methodology based on one-step 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC)-mediated reaction. The dual-peak long period grating (dLPG) has been demonstrated its inherent ultrahigh sensitivity to refractive index (RI), achieving 50-fold improvement in RI sensitivity over a standard LPG sensor used in low RI range. With the simple and efficient immobilization of unmodified oligonucleotides on sensor surface, dLPG-based biosensor has been used to monitor the hybridization of complementary oligonucleotides showing a detectable oligonucleotide concentration of 4 nM with the advantages of label-free, real-time, and ultrahigh sensitivity.

Modifications in Early Rehabilitation Protocol after Rotator Cuff Repair : EMG Studies

La déchirure de la coiffe des rotateurs est une des causes les plus fréquentes de douleur et de dysfonctionnement de l'épaule. La réparation chirurgicale est couramment réalisée chez les patients symptomatiques et de nombreux efforts ont été faits pour améliorer les techniques chirurgicales. Cependant, le taux de re-déchirure est encore élevé ce qui affecte les stratégies de réhabilitation post-opératoire. Les recommandations post-chirurgicales doivent trouver un équilibre optimal entre le repos total afin de protéger le tendon réparé et les activités préconisées afin de restaurer l'amplitude articulaire et la force musculaire. Après une réparation de la coiffe, l'épaule est le plus souvent immobilisée grâce à une écharpe ou une orthèse. Cependant, cette immobilisation limite aussi la mobilité du coude et du poignet. Cette période qui peut durer de 4 à 6 semaines où seuls des mouvements passifs peuvent être réalisés. Ensuite, les patients sont incités à réaliser les exercices actifs assistés et des exercices actifs dans toute la mobilité articulaire pour récupérer respectivement l’amplitude complète de mouvement actif et se préparer aux exercices de résistance réalisés dans la phase suivante de la réadaptation. L’analyse électromyographique des muscles de l'épaule a fourni des évidences scientifiques pour la recommandation de beaucoup d'exercices de réadaptation au cours de cette période. Les activités sollicitant les muscles de la coiffe des rotateurs à moins de 20% de leur activation maximale volontaire sont considérés sécuritaires pour les premières phases de la réhabilitation. À partir de ce concept, l'objectif de cette thèse a été d'évaluer des activités musculaires de l'épaule pendant des mouvements et exercices qui peuvent théoriquement être effectués au cours des premières phases de la réhabilitation. Les trois questions principales de cette thèse sont : 1) Est-ce que la mobilisation du coude et du poignet produisent une grande activité des muscles de la coiffe? 2) Est-ce que les exercices de renforcement musculaire du bras, de l’avant-bras et du torse produisent une grande activité dans les muscles de la coiffe? 3) Au cours d'élévations actives du bras, est-ce que le plan d'élévation affecte l'activité de la coiffe des rotateurs? Dans notre première étude, nous avons évalué 15 muscles de l'épaule chez 14 sujets sains par électromyographie de surface et intramusculaire. Nos résultats ont montré qu’avec une orthèse d’épaule, les mouvements du coude et du poignet et même quelques exercices de renforcement impliquant ces deux articulations, activent de manière sécuritaire les muscles de ii la coiffe. Nous avons également introduit des tâches de la vie quotidienne qui peuvent être effectuées en toute sécurité pendant la période d'immobilisation. Ces résultats peuvent aider à modifier la conception d'orthèses de l’épaule. Dans notre deuxième étude, nous avons montré que l'adduction du bras réalisée contre une mousse à faible densité, positionnée pour remplacer le triangle d’une orthèse, produit des activations des muscles de la coiffe sécuritaires. Dans notre troisième étude, nous avons évalué l'électromyographie des muscles de l’épaule pendant les tâches d'élévation du bras chez 8 patients symptomatiques avec la déchirure de coiffe des rotateurs. Nous avons constaté que l'activité du supra-épineux était significativement plus élevée pendant l’abduction que pendant la scaption et la flexion. Ce résultat suggère une séquence de plan d’élévation active pendant la rééducation. Les résultats présentés dans cette thèse, suggèrent quelques modifications dans les protocoles de réadaptation de l’épaule pendant les 12 premières semaines après la réparation de la coiffe. Ces suggestions fournissent également des évidences scientifiques pour la production d'orthèses plus dynamiques et fonctionnelles à l’articulation de l’épaule.

Fabrication of heterogeneous biocatalyst tethering artificial prosthetic groups to obtain omega-3-fatty acids by selective hydrolysis of fish oils

The active site of lipase from Bacillus thermocathenolatus was selectively modified with allyl and naphthyl chains at different positions. Lipase immobilization and selective tethering of a naphthyl side chain to its position 320 improve both the hydrolysis rate of fish oils and the selectivity towards the eicosapentaenoic acid acyl chains. © The Royal Society of Chemistry 2016.

Well-controlled preparation of evenly distributed nanoporous HOPG surface via diazonium salt assisted electrochemical etching process

Evenly distributed nanoporous highly oriented pyrolytic graphite (HOPG) surfaces with controllable pore size were successfully prepared via diazonium salt assisted electrochemical etching method. The porous HOPG was investigated by atomic force microscopy (AFM), Fourier transform infrared spectroscopy (FT-IR), X-ray photoelectron spectroscopy (XPS) Raman spectroscopy and X-ray diffraction. The size of these pores can be tuned by manipulating the electrochemical etching time. These porous HOPG substrates also demonstrated the enhanced electrocatalytical behaviour and were employed as benign arena for the immobilization of Ru(bpy)32+ for electrochemiluminescence (ECL) sensing applications.

Modifications in Early Rehabilitation Protocol after Rotator Cuff Repair : EMG Studies

La déchirure de la coiffe des rotateurs est une des causes les plus fréquentes de douleur et de dysfonctionnement de l'épaule. La réparation chirurgicale est couramment réalisée chez les patients symptomatiques et de nombreux efforts ont été faits pour améliorer les techniques chirurgicales. Cependant, le taux de re-déchirure est encore élevé ce qui affecte les stratégies de réhabilitation post-opératoire. Les recommandations post-chirurgicales doivent trouver un équilibre optimal entre le repos total afin de protéger le tendon réparé et les activités préconisées afin de restaurer l'amplitude articulaire et la force musculaire. Après une réparation de la coiffe, l'épaule est le plus souvent immobilisée grâce à une écharpe ou une orthèse. Cependant, cette immobilisation limite aussi la mobilité du coude et du poignet. Cette période qui peut durer de 4 à 6 semaines où seuls des mouvements passifs peuvent être réalisés. Ensuite, les patients sont incités à réaliser les exercices actifs assistés et des exercices actifs dans toute la mobilité articulaire pour récupérer respectivement l’amplitude complète de mouvement actif et se préparer aux exercices de résistance réalisés dans la phase suivante de la réadaptation. L’analyse électromyographique des muscles de l'épaule a fourni des évidences scientifiques pour la recommandation de beaucoup d'exercices de réadaptation au cours de cette période. Les activités sollicitant les muscles de la coiffe des rotateurs à moins de 20% de leur activation maximale volontaire sont considérés sécuritaires pour les premières phases de la réhabilitation. À partir de ce concept, l'objectif de cette thèse a été d'évaluer des activités musculaires de l'épaule pendant des mouvements et exercices qui peuvent théoriquement être effectués au cours des premières phases de la réhabilitation. Les trois questions principales de cette thèse sont : 1) Est-ce que la mobilisation du coude et du poignet produisent une grande activité des muscles de la coiffe? 2) Est-ce que les exercices de renforcement musculaire du bras, de l’avant-bras et du torse produisent une grande activité dans les muscles de la coiffe? 3) Au cours d'élévations actives du bras, est-ce que le plan d'élévation affecte l'activité de la coiffe des rotateurs? Dans notre première étude, nous avons évalué 15 muscles de l'épaule chez 14 sujets sains par électromyographie de surface et intramusculaire. Nos résultats ont montré qu’avec une orthèse d’épaule, les mouvements du coude et du poignet et même quelques exercices de renforcement impliquant ces deux articulations, activent de manière sécuritaire les muscles de ii la coiffe. Nous avons également introduit des tâches de la vie quotidienne qui peuvent être effectuées en toute sécurité pendant la période d'immobilisation. Ces résultats peuvent aider à modifier la conception d'orthèses de l’épaule. Dans notre deuxième étude, nous avons montré que l'adduction du bras réalisée contre une mousse à faible densité, positionnée pour remplacer le triangle d’une orthèse, produit des activations des muscles de la coiffe sécuritaires. Dans notre troisième étude, nous avons évalué l'électromyographie des muscles de l’épaule pendant les tâches d'élévation du bras chez 8 patients symptomatiques avec la déchirure de coiffe des rotateurs. Nous avons constaté que l'activité du supra-épineux était significativement plus élevée pendant l’abduction que pendant la scaption et la flexion. Ce résultat suggère une séquence de plan d’élévation active pendant la rééducation. Les résultats présentés dans cette thèse, suggèrent quelques modifications dans les protocoles de réadaptation de l’épaule pendant les 12 premières semaines après la réparation de la coiffe. Ces suggestions fournissent également des évidences scientifiques pour la production d'orthèses plus dynamiques et fonctionnelles à l’articulation de l’épaule.

A new post-metallocene-ti catalyst with maltolate bidentade ligand: an investigation in heterogeneous polymerization reactions in different mesoporous supports

A new titanium catalyst easily synthesized from ethylmaltol bidentate chelator ligand was studied in homogeneous and heterogeneous ethylene polymerization. The dichlorobis(3-hydroxy-2-ethyl-4-pyrone)titanium(IV) complex was characterized by 1H and 13C NMR (nuclear magnetic resonance), UV-Vis and elemental analysis. Theoretical study by density functional theory (DFT) showed that the complex chlorines exhibit cis configuration, which is important for the activity in olefin polymerization. The complex was supported by two methods, direct impregnation or methylaluminoxane (MAO) pre-treatment, in five mesoporous supports: MCM-41 (micro and nano), SBA-15 and also the corresponding modified Al species. All the catalytic systems were active in ethylene polymerization and the catalytic activity was strongly influenced by the method of immobilization of the catalyst and the type of support.

Nitrogen use efficiency and optimization of nitrogen fertilizer application for stable yields and high quality of cereals grown in conservation agriculture

In most agroecosystems, nitrogen (N) is the most important nutrient limiting plant growth. One management strategy that affects N cycling and N use efficiency (NUE) is conservation agriculture (CA), an agricultural system based on a combination of minimum tillage, crop residue retention and crop rotation. Available results on the optimization of NUE in CA are inconsistent and studies that cover all three components of CA are scarce. Presently, CA is promoted in the Yaqui Valley in Northern Mexico, the country´s major wheat-producing area in which from 1968 to 1995, fertilizer application rates for the cultivation of irrigated durum wheat (Triticum durum L.) at 6 t ha-1 increased from 80 to 250 kg ha-1, demonstrating the high intensification potential in this region. Given major knowledge gaps on N availability in CA this thesis summarizes the current knowledge of N management in CA and provides insights in the effects of tillage practice, residue management and crop rotation on wheat grain quality and N cycling. Major aims of the study were to identify N fertilizer application strategies that improve N use efficiency and reduce N immobilization in CA with the ultimate goal to stabilize cereal yields, maintain grain quality, minimize N losses into the environment and reduce farmers’ input costs. Soil physical and chemical properties in CA were measured and compared with those in conventional systems and permanent beds with residue burning focusing on their relationship to plant N uptake and N cycling in the soil and how they are affected by tillage and N fertilizer timing, method and doses. For N fertilizer management, we analyzed how placement, time and amount of N fertilizer influenced yield and quality parameters of durum and bread wheat in CA systems. Overall, grain quality parameters, in particular grain protein concentration decreased with zero-tillage and increasing amount of residues left on the field compared with conventional systems. The second part of the dissertation provides an overview of applied methodologies to measure NUE and its components. We evaluated the methodology of ion exchange resin cartridges under irrigated, intensive agricultural cropping systems on Vertisols to measure nitrate leaching losses which through drainage channels ultimately end up in the Sea of Cortez where they lead to algae blooming. A throughout analysis of N inputs and outputs was conducted to calculate N balances in three different tillage-straw systems. As fertilizer inputs are high, N balances were positive in all treatments indicating the risk of N leaching or volatilization during or in subsequent cropping seasons and during heavy rain fall in summer. Contrary to common belief, we did not find negative effects of residue burning on soil nutrient status, yield or N uptake. A labeled fertilizer experiment with urea 15N was implemented in micro-plots to measure N fertilizer recovery and the effects of residual fertilizer N in the soil from summer maize on the following winter crop wheat. Obtained N fertilizer recovery rates for maize grain were with an average of 11% very low for all treatments.

Estudo do comportamento do chumbo em latossolos brasileiros tratados com fosfatos: contribuições para a remediação de sítios contaminados.

Phosphates have been used for lead immobilization in soils but the influence of soil type is not fully understood. In this work, lead chemical behaviour in two Brazilian latosoils (LA and LV) was studied via treatment with phosphates. The Pb concentration in Toxicity Characteristic Leaching Procedure (TCLP) solutions was decreased in all treatments. After treatment with H3PO4 the Pb concentration in the LA remained within the regulatory limit established by EPA. The ecotoxicological results with Daphnia pulex showed that this treatment reduced the lead bioavailability. Sequential extraction analyses showed that the lead was transferred from the most available to the residual fraction. Relevant decrease of soluble lead was observed in all phosphate treatments.