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The photoanode of a dye-sensitized solar cell (DSSC), usually made with a nanoporous TiO2 semiconductor layer sensitized with N719 dye, plays a crucial role in the overall power conversion efficiency as it influences both the light absorption and the electron transport. Generally, enhanced photon absorbance is achieved through light scattering in the device by employing a double-layered TiO2 photoanode consisting of an active layer of smaller (~ 20 nm) P25 particles and a scattering layer consisting of larger (~ 300 nm) particles. However, due to the smaller effective surface area of the larger particle layer, the dye adsorption in the second layer is very poor, and therefore, the efficiency enhancement due to the usage of thicker photo anode is hindered. Therefore, in this study, investigations were carried out to replace the conventional, larger particle scattering layer by a morphologically different structure of TiO2. Here, the DSSC performance between two different types of scattering layers, one consisting of TiO2 nanorods (NRs) and the other consisting of hierarchically structured TiO2 submicron size spheres (MS) are compared. DSSC fabricated with P25/MS double-layered photoanode outperforms the DSSC fabricated with P25/NR double-layered photoanode. P25/MS-based DSSC delivered a highest short-circuit current density of 14.80 mA cm−2 with an efficiency of 7.38%, while the efficiency of DSSC fabricated with P25/NR photoanode exhibits 7.03% efficiency. The DSSC fabricated without a scattering layer showed only 6.68% efficiency. The diffuse reflectance and dye adsorption measurements revealed that the better performance of P25/MS double-layered DSSC is largely due to the improved photon absorption facilitated by superior light scattering as well as higher dye loading by TiO2 submicron size spheres. [ABSTRACT FROM AUTHOR]

Scouting for novel and plant-derived biomolecules from endophytic microbial sources draws greater focus on the discovery of novel bioactive metabolites. With this rationale, we scouted the endophytic fungi for taxol, an anticancer diterpenoid and fluorescent biomolecules. In the present study, about 31 endophytic fungal isolates recovered from the Mangifera indica leaves were screened for taxol production in M1D medium. About five isolates were shortlisted based on the thin layer chromatographic analysis of the fungal extracts. Among them Colletotrichum sp. MIP-5 has been identified as a producer of fungal taxol based on UV, FTIR, TLC and HPLC analysis. The partially purified fungal taxol showed similar spectral and chromatographic features of commercially available paclitaxel. In addition to this, we also report the production of a fluorescent compound by Penicillium sp. MIP-3. The Flavin-like compound exhibited a bright greenish-yellow fluorescence with an emission maximum in the range of 505 – 545nm. GC-MS analysis showed the occurrence of Latia luciferin, primarily associated with the bioluminescence of freshwater limpet Latia neritoides. This is the first report of this compound from Penicillium sp. In addition, therapeutically active steroid (β-Sitosterol, Stigmasterol, Campesterol), quinones (Benzo[h]quinoline, 2,4-dimethyl-) and phloroglucinol (Aspidinol) derivatives were also identified from Penicillium sp. MIP-3 based on GC-MS analysis. These molecules could potentially be used in biological and pharmaceutical applications in future.

We describe a case of airway obstruction secondary to a large pre-vertebral cervico-mediastinal haematoma following failed attempts at insertion of an internal jugular central venous line. The need for a high index of suspicion to diagnose this injury and early aggressive intervention to manage it are outlined. The role of ultrasound guidance in preventing such a complication is reviewed, as well as other possible mechanisms of haematoma development. [ABSTRACT FROM AUTHOR]

This study reports the incidence and associated mortality of acquired hypernatraemia (Na > 150 mmol.l−1) in a general medical/surgical intensive care unit. Patients admitted over a 5-year period with normal sodium values were eligible for inclusion; exclusions were made for burn/neurosurgical diagnoses and for hypertonic saline therapy. From 3475 admissions (3317 patients), 266 (7.7%) episodes of hypernatraemia were observed. Hospital mortality was 33.5% in the hypernatraemic group and 7.7% in the normonatraemic group (p < 0.001). Acquired hypernatraemia was an independent risk factor for in-hospital mortality (OR 1.97, 95% CI 1.37–2.82, p < 0.001). Intermediate sodium levels (145–150 mmol.l−1) were associated with increased mortality (OR 1.42, 95% CI 1.02–1.98). Uncorrected sodium at discharge (p = 0.001) and peak sodium (p = 0.001) were better predictors of mortality than time to onset (p = 0.71) and duration of hypernatraemia (p = 1.0). Hypernatraemia avoidance is justified, but determinants of hypernatraemia and benefits of targeted treatment strategies require further elucidation. [ABSTRACT FROM AUTHOR]

Background: Although comorbid medical diseases are important determinants of outcome among the critically ill, the role of psychiatric comorbidity is not well defined. The objective of this study was to determine the occurrence of psychiatric comorbidity and its effect on the outcome of patients admitted to adult intensive care units (ICU) in Queensland., Methods: Admissions among adults to 12 ICUs in Queensland during 2015-2021 were included and clinical and outcome information was obtained through linkages between the ANZICS Adult Patient Database, the state-wide Queensland Hospital Admitted Patient Data Collection, and death registry., Results: A total of 89,123 admissions were included among 74,513 individuals. Overall, 7,178 (8.1%) admissions had psychiatric co-morbidity with 6,270 (7.0%) having one major psychiatric diagnosis and 908 (1%) having two or more. Individual diagnoses of mood, psychotic, anxiety, or affective disorders were present in 1,801 (2.0%), 874 (1.0%), 3,241 (3.6%) and 354 (0.4%) admissions respectively. Significant differences were observed among the main groups (mood, affective, anxiety, psychotic, or multiple disorders) and those without psychiatric comorbidity with respect to main diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) score, sex, age, and medical comorbidity. Crude 30-day case-fatality rates were significantly lower (5.1%) compared to the general ICU population (10.1%) (p < 0.001). After controlling for confounding variables in the logistic regression model, patients with psychiatric comorbidity were at lower odds of death., Conclusions: Psychiatric comorbidity is common among ICU presentations and is associated with a lower risk of death. This association is likely to be more complex than being a simple protective factor, and future research needs to further delineate how psychiatric comorbidity informs outcomes of specific ICU presentations., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Metro South Hospital and Health Service Human Research Ethics Committee (HREC/2022/QMS/82024) with an individual waiver of consent granted. Individual informed consent was not required.  Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: Clinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO 2  > 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis., Material and Methods: Multicentre, retrospective, observational study conducted in 12 intensive care units (ICUs) in Queensland, Australia. Patients with metabolic acidosis and concurrent vasopressor requirement were included and the exposure of interest was the PaCO 2 level at the time of meeting the eligibility criteria divided in two groups: PaCO 2  ≤ 45 mmHg and PaCO 2 46-50 mmHg. Primary clinical outcome was major adverse kidney events within 30 days (MAKE30)., Results: We studied 5601 patients, with 3605 (64.4 %) in the PaCO 2  ≤ 45 mmHg group and 1996 (35.6 %) in the PaCO 2 46-50 mmHg group. The incidence of MAKE30 was lower in the PaCO 2 46-50 mmHg group (29 % vs. 34 %; OR, 0.79 [95 %CI, 0.69 to 0.90]; p < 0.001) as was the use of renal replacement therapy, and the incidence of acute kidney injury. After adjustment for confounders, no outcome was different between the groups. The maximum fall of pH associated with an increase of 1 mmHg of PaCO 2 in the PaCO 2 46-50 mmHg group was 0.006., Conclusion: In patients with metabolic acidosis, after adjustment for potential confounders, mild hypercapnia does not increase the MAKE-30 rate and does not have a major impact on pH., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Septic shock is common and associated with significant morbidity and mortality. The ADRENAL trial examined the use of hydrocortisone in patients with septic shock, demonstrating no difference in patient-centred outcomes but a decrease in the time to shock resolution. The change in clinical practice related to the publication of the ADRENAL trial is currently unknown., Methods: A retrospective cohort study examining the use of hydrocortisone in patients with septic shock was conducted in 12 intensive care units (ICUs). A segmented linear regression was performed to identify a stepwise change in hydrocortisone administration and 90-day mortality associated with the publication of the ADRENAL trial., Results: We included 4,198 patients with a mean age of 58 years (standard deviation, SD17), and the median noradrenaline equivalent score (NEE) was 0.07 μg/kg/min (IQR 0.02-0.17). Segmented regression analysis for hydrocortisone administration identified two breakpoints, 3 months before and 6 months after publication, leading to three periods: Pre-publication, Transition, and Post-publication. Compared to the pre-publication period, the Transition and Post-publication cohorts had a higher proportion of hydrocortisone administration (28% vs. 34% vs. 43%; p < 0.0001). Furthermore, after adjustment for temporal change, the transition period had a significant change in the slope of the proportion of patients receiving hydrocortisone (-0.1% per month vs. +1.4% per month; p = 0.026), whereas this was not statistically significant during the post-publication period (+0.1% per month, p = 0.66). After adjusting for confounders, the Transition and Post-publication periods were independently associated with an increase in hydrocortisone (OR 1.4, 95% CI 1.14-1.77; p = 0.0015 and OR 2.03; 95% CI 1.74-2.36; p < 0.001, respectively). Furthermore, after adjusting for confounders, when compared to the Pre-transition period, the use of hydrocortisone was associated with a statistically significant decrease in 90-day mortality (14% vs. 24% absolute difference, aHR for hydrocortisone effect -0.81; 95% CI 0.65-0.99; p = 0.044)., Conclusion: Publication of the ADRENAL trial changed clinical practice in Queensland ICUs with increased prescription of hydrocortisone for patients with septic shock with an associated reduction in mortality., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Aim: The features and outcomes of sepsis-associated acute kidney injury (SA-AKI) may be affected by chronic kidney disease (CKD). Accordingly, we aimed to compare SA-AKI in patients with or without CKD., Methods: Retrospective cohort study in 12 intensive care units (ICU). We studied the prevalence, patient characteristics, timing, trajectory, treatment and outcomes of SA-AKI with and without CKD., Results: Of 84 240 admissions, 7255 (8.6%) involved patients with CKD. SA-AKI was more common in patients with CKD (21% vs 14%; p < .001). CKD patients were older (70 vs. 60 years; p < .001), had a higher median Charlson co-morbidity index (5 vs. 3; p < .001) and acute physiology and chronic health evaluation (APACHE) III score (78 vs. 60; p < .001) and were more likely to receive renal replacement therapy (RRT) (25% vs. 17%; p < .001). They had less complete return to baseline function at ICU discharge (48% vs. 60%; p < .001), higher major adverse kidney events at day 30 (MAKE-30) (38% vs. 27%; p < .001), and higher hospital and 90-day mortality (21% vs. 13%; p < .001, and 27% vs. 16%; p < .001, respectively). After adjustment for patient characteristics and severity of illness, however, CKD was not an independent risk factor for increased 90-day mortality (OR 0.88; 95% CI 0.76-1.02; p = .08) or MAKE-30 (OR 0.98; 95% CI 0.80-1.09; p = .4)., Conclusion: SA-AKI is more common in patients with CKD. Such patients are older, more co-morbid, have higher disease severity, receive different ICU therapies and have different trajectories of renal recovery and greater unadjusted mortality. However, after adjustment day-90 mortality and MAKE-30 risk were not increased by CKD., (© 2024 The Author(s). Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.)

Although critically ill patients with bloodstream infections (BSIs) who present with hypothermia are at the highest risk for death, it is not known how rewarming rates may influence the outcomes. The objective of this study was to identify the occurrence and determinants of hypothermia among patients admitted to intensive care units (ICUs) with BSI and assess how the rate of temperature correction may influence 90-day all-cause case-fatality. A cohort of 3951 ICU admissions associated with BSI was assembled. The lowest temperature measured within the first 24 hours of admission was identified, and among those who were hypothermic (<36°C), the rewarming rate [(time difference between lowest and subsequent first temperature ≥36°C) divided by hypothermia severity (difference between lowest measured and 36°C)] was determined. Within the first 24 hours of admission to the ICU, 329 (8.4%) and 897 (22.7%) subjects had the lowest temperature measurements ranging <34.9°C and 35-35.9°C, respectively. Patients with lower temperatures were more likely to be admitted to tertiary care ICUs, have more comorbid illnesses, have greater severity of illness, and have a higher need for organ-supportive therapies. The 90-day all-cause case-fatality rate was 22.9% overall and was 45.3%, 24.8%, and 19.6% for those with the lowest 24 hours temperatures of <35°C, 35-35.9°C, and ≥36°C, respectively ( p < 0.001). Among 1133 hypothermic patients with documented temperatures corrected to the normal range while admitted to the ICU, the median rate of temperature increase was 0.24 (interquartile range, 0.13-0.45) o C/hour. After controlling for the severity of illness and comorbidity, a faster rewarming rate was associated with significantly lower 90-day case-fatality. Hypothermia is a significant risk factor associated with death among critically ill patients with BSI that faster rates of rewarming may modify.