Search

Purpose: Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship. Design/Methods: We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude. Results: Median durations ofmechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001).Median durations of ICUlength of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P b .001). There was no difference in hospital LOS, hospital mortality, rates of ventilator-associated pneumonia, or reintubation rates between the 2 groups.We identified 4 independent predictors of weaning duration: nurse-drivenweaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale). Conclusions: A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians. [ABSTRACT FROM AUTHOR]

Island bird populations and their obligate blood parasites are of interest for understanding the accumulation of biodiversity and the evolutionary relationship with their mainland congeners. We examined avian Haemosporidia cytochrome b gene among terrestrial birds on Gorgona Island National Park, Colombia. Three Haemoproteu s haplotype groups found on Gorgona Island have a higher genetic similarity to Haemoproteus found in the eastern tropical Pacific than those documented in Africa, Asia, Europe and Oceania. Two of the haplotype groups on the island are generalists in terms of infecting multiple hosts and their wide geographical distribution within the eastern tropical Pacific region, a third Haemoproteus haplogroup appears endemic to Gorgona Island. The overall prevalence of haemosporidian parasites is 57,9% for birds on Gorgona island, which is higher than local reports of prevalence documented in other archipelagos or the mainland. The island population of Cyanerpes cyaneus gigas seems to be the most susceptible to Haemoproteus infection when compared to Thamnophilus atrinucha gorgonae and Coereba flaveola gorgonae. Our findings support an ubiquitous pattern of endemism among organisms including avian haemosporidian parasites on Gorgona Island and also highlight the potential exposure of island bird populations to avian malaria. • Prevalence on Gorgona Island is higher than any local report in the Americas. • Specific host-species effect of avian Haemosporidia to Gorgona Island. • An avian Haemoproteus might be endemic to Gorgona Island. • Haemoproteus on Gorgona Island is similar to those circulating in the Americas. [ABSTRACT FROM AUTHOR]

• HSAD with percolate recirculation was operated for methane recovery from OFMSW. • Microbial community structure successions in solid and liquid phases were studied. • Microbial community diversity decreased over batch operation. • Hydrogenotrophic archaea and ammonia-tolerant microbes were found to be dominant. • Dynamic changes in VFA/Alkalinity, TAN, and pH affected community shifts. This study presents a microbiological diagnosis of a mesophilic high-solids anaerobic digestion (HSAD) system with percolate recirculation. The results demonstrated a significant decrease in microbial diversity in both the solid digestate and the liquid percolate. Also, the digestate from the top and middle sections of the digester had similar diversity, whereas the digestate from the bottom of the tank had a slightly lower diversity. These results suggest that despite percolate recirculation, substrate gradients might have developed across the system. Archaeal communities showed shifts towards known hydrogenotrophic and ammonia-tolerant methanogens (genera Methanocelleus , Methanolinea , Methanosarcina, vadin CA11, etc.), which was a consequence of decreased volatile fatty acids and increased ammonia-nitrogen levels over time. Compared to initial solid and liquid inoculum, the relative abundances of some bacteria (phyla Proteobacteria and Firmicutes) and archaea of the genus Methanosarcina changed between two phases in the opposite direction, indicating a shift of microbes between two phases. [ABSTRACT FROM AUTHOR]