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Background Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment. Aim To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients. Methods We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta‐analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta‐analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks’ funnel plot. Data Synthesis We identified and evaluated 23 and 8 articles focused on CAM‐ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM‐ICU and ICDSC, respectively. The AUC of the CAM‐ICU was 0.96 (95% CI, 0.94–0.98), with DOR at 99 (95% CI, 55–177). The AUC of the ICDSC was 0.95 (95% CI, 0.92–0.96), and the DOR was 65 (95% CI, 27–153). Linking Evidence to Action CAM‐ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between‐study heterogeneity of this

A colistin-glycopeptide combination (CGC) has been shown in vitro to be synergistic against multidrug-resistant Gram-negative bacteria (MDR GNB), especially Acinetobacter baumannii, and to prevent further resistance. However, clinical data are lacking. We carried out a retrospective multicenter study of patients hospitalized in intensive care units (ICUs) who received colistin for GNB infection over a 1-year period, to assess the rates of nephrotoxicity and 30-day mortality after treatment onset among patients treated with and without CGC for ≥48 h. Of the 184 patients treated with colistin, GNB infection was documented for 166. The main causative agents were MDR A. baumannii (59.6%), MDR Pseudomonas aeruginosa (18.7%), and carbapenem-resistant Klebsiella pneumoniae (14.5%); in 16.9% of patients, a Gram-positive bacterium (GPB) coinfection was documented. Overall, 68 patients (40.9%) received CGC. Comparison of patients treated with and without CGC showed significant differences for respiratory failure (39.7% versus 58.2%), ventilator-associated pneumonia (54.4% versus 71.4%), MDR A. baumannii infection (70.6% versus 52%), and GPB coinfection (41.2% versus 0%); there were no differences for nephrotoxicity (11.8% versus 13.3%) and 30-day mortality (33.8% versus 29.6%). Cox analysis performed on patients who survived for ≥5 days after treatment onset showed that the Charlson index (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.01 to 1.44; P = 0.001) and MDR A. baumannii infection (HR, 2.51; 95% CI, 1.23 to 5.12; P = 0.01) were independent predictors of 30-day mortality, whereas receiving CGC for ≥5 days was a protective factor (HR, 0.42; 95% CI, 0.19 to 0.93; P = 0.03). We found that CGC was not associated with higher nephrotoxicity and was a protective factor for mortality if administered for ≥5 days.

Pyxis arachnoides inhabits the dry, coastal forests of southwest Madagascar; a biologically unique ecoregion severely threatened by unsustainable small scale agricultural practices. Using remotely sensed data we established vegetation loss remains unabated within our study area at 1.2% year-1; consistent with ecoregion wide vegetation loss between 1990 and 2000. We monitored tortoise population density on four occasions over 8 years and developed a stage class projection matrix to model the finite growth rate, matrix sensitivities and elasticities of the population. Monitoring revealed an actual mean population decline of 10.8% between 2003 and 2011. Our projection matrix model suggested the finite rate of growth to be ʎ = 0.986, indicative of 1.4% year-1 decline for the duration of the existence of the population, with adult survival as the most sensitive parameter to overall survival of the population. Projection modeling suggests that the population would possibly become functionally non viable in approximately 170 years. As our study was heavily reliant on the use of surrogate data, more information is needed on pre-adult survival and wild reproductive rates. Our study site currently represents a population of exceptional density, therefore, other less dense populations, subjected to the further stresses of poaching will likely become functionally non viable much sooner. This study highlights the utility of population projection matrices in determining the vulnerability of chelonians; a globally threatened taxon. In the case of the spider tortoise, well coordinated development programs and tighter protected area management are required to address the poverty induced drivers forcing this species closer to extinction.

Pyxis arachnoides inhabits the dry, coastal forests of southwest Madagascar; a biologically unique ecoregion severely threatened by unsustainable small scale agricultural practices. Using remotely sensed data we established vegetation loss remains unabated within our study area at 1.2% year-1; consistent with ecoregion wide vegetation loss between 1990 and 2000. We monitored tortoise population density on four occasions over 8 years and developed a stage class projection matrix to model the finite growth rate, matrix sensitivities and elasticities of the population. Monitoring revealed an actual mean population decline of 10.8% between 2003 and 2011. Our projection matrix model suggested the finite rate of growth to be ʎ = 0.986, indicative of 1.4% year-1 decline for the duration of the existence of the population, with adult survival as the most sensitive parameter to overall survival of the population. Projection modeling suggests that the population would possibly become functionally non viable in approximately 170 years. As our study was heavily reliant on the use of surrogate data, more information is needed on pre-adult survival and wild reproductive rates. Our study site currently represents a population of exceptional density, therefore, other less dense populations, subjected to the further stresses of poaching will likely become functionally non viable much sooner. This study highlights the utility of population projection matrices in determining the vulnerability of chelonians; a globally threatened taxon. In the case of the spider tortoise, well coordinated development programs and tighter protected area management are required to address the poverty induced drivers forcing this species closer to extinction.

Pyxis arachnoides inhabits the dry, coastal forests of southwest Madagascar; a biologically unique ecoregion severely threatened by unsustainable small scale agricultural practices. Using remotely sensed data we established vegetation loss remains unabated within our study area at 1.2% year-1; consistent with ecoregion wide vegetation loss between 1990 and 2000. We monitored tortoise population density on four occasions over 8 years and developed a stage class projection matrix to model the finite growth rate, matrix sensitivities and elasticities of the population. Monitoring revealed an actual mean population decline of 10.8% between 2003 and 2011. Our projection matrix model suggested the finite rate of growth to be ʎ = 0.986, indicative of 1.4% year-1 decline for the duration of the existence of the population, with adult survival as the most sensitive parameter to overall survival of the population. Projection modeling suggests that the population would possibly become functionally non viable in approximately 170 years. As our study was heavily reliant on the use of surrogate data, more information is needed on pre-adult survival and wild reproductive rates. Our study site currently represents a population of exceptional density, therefore, other less dense populations, subjected to the further stresses of poaching will likely become functionally non viable much sooner. This study highlights the utility of population projection matrices in determining the vulnerability of chelonians; a globally threatened taxon. In the case of the spider tortoise, well coordinated development programs and tighter protected area management are required to address the poverty induced drivers forcing this species closer to extinction.

Background: Conservation Breeding Programs (CBP's) are playing an important role in the protection of critically endangered anuran amphibians, but for many species recruitment is not successful enough to maintain captive populations, or provide individuals for release. In response, there has been an increasing focus on the use of Assisted Reproductive Technologies (ART), including the administration of reproductive hormones to induce gamete release followed by in vitro fertilisation. The objective of this study was to test the efficacy of two exogenous hormones to induce gamete release, for the purpose of conducting in vitro fertilisation (IVF), in one of Australia's most critically endangered frog species, Pseudophryne corroboree.Methods: Male frogs were administered a single dose of either human chorionic gonadotropin (hCG) or luteinizing hormone-releasing hormone (LHRHa), while female frogs received both a priming and ovulatory dose of LHRHa. Spermiation responses were evaluated at 3, 7, 12, 24, 36, 48, 60 and 72 h post hormone administration (PA), and sperm number and viability were quantified using fluorescent microscopy. Ovulation responses were evaluated by stripping females every 12 h PA for 5 days. Once gametes were obtained, IVF was attempted by combining spermic urine with oocytes in a dilute solution of simplified amphibian ringer (SAR).Results: Administration of both hCG and LHRHa induced approximately 80% of males to release sperm over 72 h. Peak sperm release occurred at 12 h PA for hCG treated males and 36 h PA for LHRHa treated males. On average, LHRHa treated males released a significantly higher total number of live sperm, and a higher concentration of sperm, over a longer period. In female frogs, administration of LHRHa induced approximately 30% of individuals to release eggs. On average, eggs were released between 24 and 48 h PA, with a peak in egg release at 36 h PA. IVF resulted in a moderate percentage (54.72%) of eggs being fertilised, howev

Background: Conservation Breeding Programs (CBP's) are playing an important role in the protection of critically endangered anuran amphibians, but for many species recruitment is not successful enough to maintain captive populations, or provide individuals for release. In response, there has been an increasing focus on the use of Assisted Reproductive Technologies (ART), including the administration of reproductive hormones to induce gamete release followed by in vitro fertilisation. The objective of this study was to test the efficacy of two exogenous hormones to induce gamete release, for the purpose of conducting in vitro fertilisation (IVF), in one of Australia's most critically endangered frog species, Pseudophryne corroboree.Methods: Male frogs were administered a single dose of either human chorionic gonadotropin (hCG) or luteinizing hormone-releasing hormone (LHRHa), while female frogs received both a priming and ovulatory dose of LHRHa. Spermiation responses were evaluated at 3, 7, 12, 24, 36, 48, 60 and 72 h post hormone administration (PA), and sperm number and viability were quantified using fluorescent microscopy. Ovulation responses were evaluated by stripping females every 12 h PA for 5 days. Once gametes were obtained, IVF was attempted by combining spermic urine with oocytes in a dilute solution of simplified amphibian ringer (SAR).Results: Administration of both hCG and LHRHa induced approximately 80% of males to release sperm over 72 h. Peak sperm release occurred at 12 h PA for hCG treated males and 36 h PA for LHRHa treated males. On average, LHRHa treated males released a significantly higher total number of live sperm, and a higher concentration of sperm, over a longer period. In female frogs, administration of LHRHa induced approximately 30% of individuals to release eggs. On average, eggs were released between 24 and 48 h PA, with a peak in egg release at 36 h PA. IVF resulted in a moderate percentage (54.72%) of eggs being fertilised, howev

Background The optimal target range for blood glucose in critically ill patients remains unclear. Methods Within 24 hours after admission to an intensive care unit(ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter(4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter(10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization. Results Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients(27.5%) in the intensive-control group and 751(24.9%) in the conventional-control group died(odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative(surgical) patients and nonoperative(medical) patients(odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10). Severe hypoglycemia(blood glucose level, <40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients(6.8%) in the intensive-control group and 15 of 3014(0.5%) in the conventional-control group(P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU(P = 0.84) or hospital(P = 0.86) or the median number of days of mechanical ventilation(P = 0.56) or renal-replacement therapy(P=0.39). Conclusions In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or les

Background The optimal target range for blood glucose in critically ill patients remains unclear. Methods Within 24 hours after admission to an intensive care unit(ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter(4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter(10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization. Results Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients(27.5%) in the intensive-control group and 751(24.9%) in the conventional-control group died(odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative(surgical) patients and nonoperative(medical) patients(odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10). Severe hypoglycemia(blood glucose level, <40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients(6.8%) in the intensive-control group and 15 of 3014(0.5%) in the conventional-control group(P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU(P = 0.84) or hospital(P = 0.86) or the median number of days of mechanical ventilation(P = 0.56) or renal-replacement therapy(P=0.39). Conclusions In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or les

Introduced perennial grasses are capable of altering the habitat of native species, causing reductions in population size and vigour, and potentially affecting life-history processes such as survival, pollination and seedling recruitment. We examined the utility of herbicide treatment on two exotic grasses, Pennisetum clandestinum (Kikuyu) and Stenotaphrum secundatum (Buffalo grass) to restore the habitat of Calystegia affinis, a critically endangered species endemic to Lord Howe and Norfolk Islands. Using two herbicides, Asset (designed to affect only grasses) and Glyphosate (a general herbicide), we compared effectiveness in reducing grass cover on a population of Calystegia affinis. We protected Calystegia plants from the herbicides by ensuring their leaves were covered by plastic bags during herbicide application. Both herbicides were similarly effective in reducing grass cover after four weeks and had no noticeable adverse affect on Calystegia (suggesting the plastic bag protection was effective). After 26 weeks, Glyphosate was more effective in maintaining a reduced grass cover. Plots treated with either herbicide had a greater relative increase in abundance of Calystegia stems compared to untreated controls. The Glyphosate treatment resulted in the greatest relative increase in stem abundance, but this was not significantly greater than in the Asset treatment. We consider that spraying with Glyphosate treatment, with follow-up monitoring and spot-spraying, will assist the recovery of the Calystegia affinis population. Ultimately, the maintenance of a weed-free zone at the forest edge will provide suitable habitat for additional recruitment of this and other native species.

Introduced perennial grasses are capable of altering the habitat of native species, causing reductions in population size and vigour, and potentially affecting life-history processes such as survival, pollination and seedling recruitment. We examined the utility of herbicide treatment on two exotic grasses, Pennisetum clandestinum (Kikuyu) and Stenotaphrum secundatum (Buffalo grass) to restore the habitat of Calystegia affinis, a critically endangered species endemic to Lord Howe and Norfolk Islands. Using two herbicides, Asset (designed to affect only grasses) and Glyphosate (a general herbicide), we compared effectiveness in reducing grass cover on a population of Calystegia affinis. We protected Calystegia plants from the herbicides by ensuring their leaves were covered by plastic bags during herbicide application. Both herbicides were similarly effective in reducing grass cover after four weeks and had no noticeable adverse affect on Calystegia (suggesting the plastic bag protection was effective). After 26 weeks, Glyphosate was more effective in maintaining a reduced grass cover. Plots treated with either herbicide had a greater relative increase in abundance of Calystegia stems compared to untreated controls. The Glyphosate treatment resulted in the greatest relative increase in stem abundance, but this was not significantly greater than in the Asset treatment. We consider that spraying with Glyphosate treatment, with follow-up monitoring and spot-spraying, will assist the recovery of the Calystegia affinis population. Ultimately, the maintenance of a weed-free zone at the forest edge will provide suitable habitat for additional recruitment of this and other native species.

Introduced perennial grasses are capable of altering the habitat of native species, causing reductions in population size and vigour, and potentially affecting life-history processes such as survival, pollination and seedling recruitment. We examined the utility of herbicide treatment on two exotic grasses, Pennisetum clandestinum (Kikuyu) and Stenotaphrum secundatum (Buffalo grass) to restore the habitat of Calystegia affinis, a critically endangered species endemic to Lord Howe and Norfolk Islands. Using two herbicides, Asset (designed to affect only grasses) and Glyphosate (a general herbicide), we compared effectiveness in reducing grass cover on a population of Calystegia affinis. We protected Calystegia plants from the herbicides by ensuring their leaves were covered by plastic bags during herbicide application. Both herbicides were similarly effective in reducing grass cover after four weeks and had no noticeable adverse affect on Calystegia (suggesting the plastic bag protection was effective). After 26 weeks, Glyphosate was more effective in maintaining a reduced grass cover. Plots treated with either herbicide had a greater relative increase in abundance of Calystegia stems compared to untreated controls. The Glyphosate treatment resulted in the greatest relative increase in stem abundance, but this was not significantly greater than in the Asset treatment. We consider that spraying with Glyphosate treatment, with follow-up monitoring and spot-spraying, will assist the recovery of the Calystegia affinis population. Ultimately, the maintenance of a weed-free zone at the forest edge will provide suitable habitat for additional recruitment of this and other native species.