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Delirium is a common and severe complication in intensive care unit (ICU) patients with acute ischemic stroke, exacerbating cognitive and physical impairments. It prolongs hospitalization, increases healthcare costs, and raises mortality risk. Early prediction is crucial because it facilitates prompt interventions that could possibly reverse or alleviate the detrimental consequences of delirium. Braden scores, traditionally used to assess pressure injury risk, could also signal frailty, providing an early warning of delirium and aiding in prompt and effective patient management. To examine the association between the Braden score and delirium. A retrospective analysis of adult ischemic stroke patients in the ICU of a tertiary academic medical center in Boston from 2008 to 2019 was performed. Braden scores were obtained on admission for each patient. Delirium, the primary study outcome, was assessed using the Confusion Assessment Method for Intensive Care Unit and a review of nursing notes. The association between Braden score and delirium was determined using Cox proportional hazards modeling, with hazard ratios (HR) and 95% confidence intervals (CI) calculated. The study included 3,680 patients with a median age of 72 years, of whom 1,798 were women (48.9 %). The median Braden score at ICU admission was 15 (interquartile range 13–17). After adjustment for demographics, laboratory tests, severity of illness, and comorbidities, the Braden score was inversely associated with the risk of delirium (adjusted HR: 0.94, 95 % CI: 0.92–0.96, P < 0.001). The Braden score may serve as a convenient and simple screening tool to identify the risk of delirium in ICU patients with ischemic stroke. The use of the Braden score as a predictor of delirium in ischemic stroke patients in the ICU allows early identification of high-risk patients. This facilitates timely intervention, thereby improving patient outcomes and potentially reducing healthcare costs. [ABSTRACT FROM AUTHOR]

• Characterized solar irradiance variability relationship with cloud properties. • Observations taken from DOE Atmospheric Radiation Measurement site in Oklahoma. • Seasonal analysis suggests relationship is site independent. • Machine learning model developed to describe observations. • Step towards Numerical Weather Model day ahead variability forecast. A 5-year, 1-minute resolution observational dataset of clouds and solar radiation was produced that includes two metrics of the variability in surface solar irradiance due to cloud type and fractional sky cover. Multiple regression models were trained to fit observations of surface solar irradiance variability from those two cloud property predictors. We found that ensemble tree-based methods, Random Forest and Gradient Boosting Machine, have the least overfitting issues and showed the best performance with an R2 of 0.42. While the observational data trained in this study was only from one site, the U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Southern Great Plains (SGP) site in Oklahoma, initial comparisons of the seasonality of the statistics suggest that these results are relatively weather regime independent; the generality of such a finding across sites will be tested in future work. The observational data and developed machine learning model are being used to create a numerical weather prediction model parameterization to enable day-ahead solar variability prediction in a computationally efficient way. This is a first step towards creating a new paradigm of predicting day-ahead variability with the potential to provide a new tool to improve grid operation, planning, and resilience. [ABSTRACT FROM AUTHOR]

Evaluating fish behavior and migration in response to environmental changes is a fundamental component of fisheries research and recovery of freshwater ecosystems. While spatial distribution and behavior of fishes has been well studied around hydropower facilities, little research has been conducted at a mid-reach location between two dams. The Juvenile Salmon Acoustic Telemetry System (JSATS) cabled receiver system was developed and employed as a reference sensor network for detecting and tracking juvenile salmon in the Columbia River Basin. To supplement acquisition of detection and three-dimensional (3-D) tracking data to estimate survival and fish behavior in the forebays of Little Goose and Lower Monumental dams on the Snake River in eastern Washington State, a mid-reach location was needed to investigate the spatial distribution of migrating juvenile salmon in open-water conditions between the two dams. Lyons Ferry Bridge on State Route 261 at the confluence of the Snake and Palouse Rivers was chosen as the mid-reach location. A JSATS-cabled receiver system configuration was successfully designed and deployed from the bridge's pier structure. Theoretical analysis confirmed the functionality and precision of the deployment design. Validation tests demonstrated sub-meter accuracy of 3-D tracking up to a horizontal distance of 50 m upstream and downstream from the Lyons Ferry Bridge piers. Detection and tracking probabilities of the LFB cabled array were estimated to be 99.98% from field application. This research provided a detailed description of acoustic telemetry system deployment and 3-D tracking as guidance for better understanding of fish migration behavior as they pass through dams and continue downstream through the river between dams. [ABSTRACT FROM AUTHOR]

More studies showed that as a common disorder in senior population, loss of teeth could adversely affect human cognitive function, and nitric oxide (NO) might play an important role in the cognitive function. However, the underlying mechanism has not yet been well-established. The objectives of this study are to evaluate behavior changes of KM mice after loss of molars, and levels of NO and inducible nitric oxide synthase (iNOS) in the brain in molarless condition. It is hypothesized that loss of molars of the mice tested results in the cognitive impairments and that the process is mediated by NO in the brain through the signaling pathways. Morris water maze is used to test the behavioral changes after 8 weeks of the surgery. The changes of NO and iNOS are evaluated by using Griess assay, western blot, and immunohistochemistry method. The results show that 8 weeks after loss of molars, the spatial learning and memory of KM mice impair and the levels of NO and iNOS in mice hippocampus increase. These findings suggest that molar extraction is associated with the behavioral impairment, and that the changes of NO and iNOS in the hippocampus may be involved in the behavioral changes in the molarless condition. [ABSTRACT FROM AUTHOR]

Dexamethasone has been widely used in clinical practice to promote fetal lung maturity and reduce neonatal respiratory distress syndrome and perinatal mortality. Nevertheless, its administration is a double-edged sword, as a large number of studies have shown that there are obvious disadvantages in pregnant women and fetal development. In this review, we comprehensively retrospect the latest literature on the toxicological effects and mechanisms of dexamethasone on fetal development, in an attempt to provide a valuable basis for further studies and clinical trials in the future. Overall, prenatal dexamethasone exposure could lead to some adverse consequences on fetal organ systems through intrauterine programming based on the results of current animal and human researches. Potential sequelae include osteoarthritis, hypertension, fatty liver, glomerulosclerosis, depression, diabetes and infertility, some of which can pass on to the next generation. It must be noted that the evidence in humans is preliminary and limited by the small sample size. More studies in large-scale populations are needed to confirm if it raises the risk of sequelae in humans. In addition, we strongly support the application of dexamethasone as a pharmaceutical therapy in pregnant women with coronavirus disease 2019 before a better therapy is developed. However, the adverse side effects that may arise also cannot be ignored. • PDE could lead to some adverse consequences on fetal organ systems through intrauterine programming. • Most of the symptoms or sequelae caused by PDE appeared at prepuberty or early stage of adulthood. • The possibility of sequelae in humans caused by PDE need to be further investigated, especially in a larger-scale population. • We should pay close attention to the condition of fetus exposed to prenatal dexamethasone in the context of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The southwest karst area is considered to have the most vulnerable groundwater environment in China. Groundwater quality is an important factor restricting sustainable economic development. In this study, traditional water chemistry method, water quality index (WQI), and hazard index (HI) were applied to comparatively analyze the hydrochemical characteristics of groundwater and the water quality in the exposed karst region (EKR) and buried karst region (BKR) in Bama, a typical karst area in southwest China. Generally, the main water type was Ca/Mg–HCO 3. Due to the predominance of dissolution of carbonate rocks in EKR and silicate rocks in BKR, higher total dissolved solids (TDS), Ca and HCO 3 − concentrations, and lower H 2 SiO 3 content were detected in groundwater in EKR compared with BKR. As affected by weathering of rocks such as lead-zinc ore, the maximum concentrations of Zn and Sr were 11.23 mg/L and 13.30 mg/L, showing that mineral water resources are widely distributed in Bama. The ion ratios and isotope abundances (δD and δ18O) in groundwater samples indicated stronger evaporation and rock-water interaction in EKR than BKR. Human activities exerted a more significant influence on the water quality in EKR compared to BKR. The mean WQI value also suggested that the groundwater quality was better in BKR (9.56) than EKR (12.17). Although 95.7% of the water samples in the study area were classified as excellent based on their WQI values, 4.3% of the water samples still had significant health risks (HI > 1) due to the high Sb, Zn, As, and Sr concentrations. It is recommended to reduce anthropogenic pollution in EKR and develop a plan for clean production of mineral water industry according to local conditions, which will help the sustainable development of the local economy. [Display omitted] • Groundwater hydrochemistry in exposed and buried karst regions is totally different. • Aquatic environment in exposed karst regions is more sensitive than buried ones. • Sb, As, and Zn are the main trace elements which may pose non-carcinogenic risks. • Groundwater quality assessment contributes to sustainable water management. [ABSTRACT FROM AUTHOR]

Purpose To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China. Methods A decision-analytic model of a lifetime horizon was used for base case analysis from the payers’ perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon. A hazard ratio (0.54; 95% CI, 0.32–0.93) of the overall survival for sevelamer versus CBBs was used to calculate the survival of the sevelamer group. Clinical and cost data were derived from literature and health care system in the local setting. Incremental life year and quality-adjusted life year (QALY) were the primary outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the model assumptions and parameters. The results were reported in 2015 Chinese Renminbi. Findings The incremental cost per life year and per QALY gained of sevelamer versus CBBs was ¥44,475 and ¥57,910, respectively. The incremental cost per QALY gained was below the World Health Organization’s recommended cost-effectiveness threshold (¥151,070), which is 3 times the gross domestic product per capita of 2015 in China. The incremental cost-effectiveness ratio was most sensitive to the hazard ratio of overall survival with sevelamer versus CBBs in the 1-way sensitivity analysis. The cost-effectiveness acceptability curve indicated that sevelamer had a 89.6% likelihood of cost-effectiveness at the ¥151,070 threshold. Implications Sevelamer is likely to be a cost-effective option in treating hyperphosphatemia among patients with ESRD compared with CBBs in the local context of China. [ABSTRACT FROM AUTHOR]