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Background: Approximately 16%–89% of patients developed delirium during hospitalization in the intensive care unit (ICU). Studies on the accuracy and clinical application of ICU delirium screening tools exist, but the results are inconsistent. Moreover, the accuracy of different screening tools varied greatly. Aim: To compare the diagnostic accuracy of Confusion Assessment Method‐Intensive Care Unit (CAM‐ICU) and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening in critically ill patients in the ICU. Study Design: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Medline, and SciELO databases for relevant studies by combining relevant medical subject headings (MeSH) and keywords. Each database was searched from its creation to 30 January 2024. The included literature was screened by title, abstract, and full text. The diagnostic studies were summarized using Stata 14.0 software. SEN, SPE, PLR, NLR, DOR, and 95% confidence interval (CI) of the diagnostic studies were combined, the SROC analysis was performed, and the area under curve was estimated. Results: Thirty‐two articles from the database met the inclusion criteria. The number of studies on CAM‐ICU and ICDSC was 28 and 14, respectively. For CAM‐ICU, the pooled sensitivity and specificity were 0.81 (95% CI: 0.81–0.81) and 0.94 (95% CI: 0.94–0.94), and the hierarchical SROC curve was 0.96 (95% CI: 0.93–0.97). Regarding the ICDSC, The pooled sensitivity and specificity were 0.79 (95% CI: 0.68–0.86) and 0.90 (95% CI: 0.84–0.93), and the hierarchical SROC curve was 0.92 (95% CI: 0.89–0.94). Regarding the likelihood ratio, the CAM‐ICU has a high PLR of 14.24 (95% CI: 14.24–14.24) and a low NLR of 0.20 (95% CI: 0.20–0.20). The ICDSC has a low PLR of 7.64 (95% CI: 5.37–10.87) and a high NLR of 0.24 (95% CI: 0.16–0.35). Conclusions: CAM‐ICU showed good performance in terms of screening and diagnostic efficacies for delirium in critically ill patients. In view of the diagnostic accuracy of these two tools in delirium assessment, the strategies on how to increase their implementation in delirium screening among ICU patients are the focus of future research. Relevance for Clinical Practice: CAM‐ICU is recommended as the first choice to evaluate delirium in clinical practice, followed by ICDSC. Future studies can explore the predictive value of CAM‐ICU and ICDSC in different special populations and different types of delirium. [ABSTRACT FROM AUTHOR]

Background: The ideal timing of tracheostomy in intensive care units (ICUs) for critically ill patients undergoing mechanical ventilation (MV) is still a matter of debate. The aim of this work was to determine and analyze the proper timing of tracheostomy and its impact on various clinical outcomes of adult patients in ICUs undergoing MV. Material and Methods: This prospective cohort observational study was carried out on 43 critically ill patients on MV in ICU patients aged ≥18 years old, both sexes, expected to be on prolonged MV. Patients were divided into two groups: Early tracheostomy (ET) group (n=20), who submitted to tracheostomy within 10 days post intubation. and late tracheostomy (LT) group (n=23), who submitted to tracheostomy between 11- and 21 days post intubation. The correlation between the timing of tracheostomy of each group and various associated ICU clinical parameters were analyzed. Results: There was a positive correlation between ventilator-associated pneumonia (VAP) and mortality (P =0.013) which was statistically significant. There was a negative correlation between mortality and length of ICU stay (P=0.009), and duration of sedation (P=0.028) in ET Conclusions: ET had a notable benefit in VAP incidence, shortening the duration of the MV, lessening the sedation time, minimizing the risks of weaning failure and decreasing length of overall ICU stay, but it had no significant impact on mortality. [ABSTRACT FROM AUTHOR]

Background: Taurine is considered an immunomodulatory agent. From current reports on clinical studies, we conducted a systematic review and meta-analysis to investigate the effects of taurine-enhanced enteral nutrition (EN) on the outcomes of critically ill patients to resolve conflicting evidence in literature., Methods: Literature from PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, SINOMED, and WanFang databases were retrieved, and randomized controlled trials (RCTs) were identified. The time range spanned from January 1, 2000, to January 31, 2024. The Cochrane Collaboration Tool was used to evaluate the risk of bias. We used the GRADE approach to rate the quality of evidence and the I2 test to assess the statistical heterogeneity of the results. Risk ratio (RR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data., Results: Four trials involving 236 patients were finally included. The meta-analysis results indicated that taurine-enhanced EN did not reduce mortality (RR = 0.70, p = 0.45, 95% CI [0.28, 1.80], two trials, 176 participants, low quality). There was also no significant difference in length of stay in the intensive care unit (ICU) between the taurine-enhanced EN and control groups. Taurine-enhanced EN may reduce pro-inflammatory factor interleukin-6 (IL-6) levels in critically ill patients（the result about IL-6 cannot be pooled）. However, taurine-enhanced EN had no significant impact on high-sensitivity-C-reactive protein levels (MD = -0.41, p = 0.40, 95% CI [-1.35, 0.54], two trials, 60 participants, low quality)., Discussion: Taurine-enhanced EN may reduce IL-6 levels and is not associated with improved clinical outcomes in critically ill patients, which may have potential immunoregulatory effects in critically ill patients. Given that published studies have small samples, the above conclusions need to be verified by more rigorously designed large-sample clinical trials., Competing Interests: Declaration of competing interest In this manuscript, all authors have completed the financial and personal relationships dis-closure form and declare that there was no conflict of interest in the study and there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Torath is said to be a collection of literary and historical heritage that has been inherited from our ancestors and naturally written with their condition. Throughout history, due to changes made in the language, sometimes writing has become different from generation to generation, and therefore it is difficult to understand the writings of the predecessors. The longer the text is older, the more difficult it is. In addition, the problem will be doubled when such texts should be translated. It is clear that all people cannot go to the original texts and have to use their translations. This is where the role of the translator as a mediator emerges. The translation will become more and more true and influent to the extent that the translator translates in a field that he has capability and has a mastery in the language of origin and destination.

A proposal of hierarchization technology applied to technological systems is the main subject of this research, focused on biopharmaceutical enterprises. Such classification hierarchizes the universe of assets involved in production process, according to new trends in maintenance. Methods such as surveying and mathematical modeling were used to obtain two mathematical models for the analysis of criticality and complexity, as well as a matrix that allowed obtaining a hierarchical list of assets. The mathematical models obtained were applied and validated. Through the validation of the models and surveys, a result was obtained in the form of a hierarchical list from the comparison, through a matrix. [ABSTRACT FROM AUTHOR]

In Urdu literature autobiography is a popular genre, however we can find many male writers in this field but renowned females are very rare. It has been said that female writers do not have courage to come in this field. Kishwar Naheed's autobiography "Buri Aurat ki Katha" proved it wrong. This article is critically examining the individual style of Kishwar Naheed in her autobiography. This autobiography is self-explanatory, dramatic in technical sense, courageous style, blunt writing with little sarcasm and emotionally expressive. These characteristics gave a uniqueness and individualistic style to Kishwar among her peers. [ABSTRACT FROM AUTHOR]

Background: Training in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported., Objective: This study aimed to evaluate medical students' perspectives and emotional preparedness for handling acute care and trauma., Methods: We conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources., Results: A total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact., Conclusions: In this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources., (©Anish Kumar Agarwal, Rachel Gonzales, Cory Munden, DaCarla Albright, Suzana Tsao. Originally published in JMIR Formative Research (https://formative.jmir.org), 10.01.2024.)

Purpose: This study was undertaken to investigate the efficacy of red blood cell transfusion (RBCT) at reversing the deleterious effects of moderate anemia in critically ill, non-bleeding patients. Methods: This was a retrospective, pair-matched (ratio 1:1) cohort study. Non-bleeding critically ill patients with moderate anemia (nadir hemoglobin level between 70 and 95 g/l), admitted to the ICU over a 27-month period, were included. Anemic patients were included upon meeting five matching criteria of having the same nadir hemoglobin (±5 g/l), APACHE II score (±5), SOFA score (±2), admission diagnostic group, and age (±5 years). Outcome events occurring over the whole ICU stay and after RBCT were collected. After hospital discharge, all patients had a 2-year follow-up period. Results: Two hundred fourteen non-transfused anemic patients (NTAPs) were successfully matched with 214 transfused anemic patients (TAPs). In addition to the matching criteria, at baseline, both groups were homogenous with respect to multiple comorbidities. Compared with TAPs, NTAPs showed significantly lower rates of hospital mortality (21 vs.13 %, respectively; p < 0.05) and ICU re-admission (7.4 vs. 1.9 %, respectively; p < 0.05). Additionally, NTAPs had significantly lower rates of nosocomial infection (12.9 vs. 6.7 %, respectively; p < 0.05) and acute kidney injury (24.8 vs. 16.7 %, respectively; p < 0.05). Similar results were obtained in subgroup analysis where only more anemic patients (68 matched pairs) or patients with cardiovascular comorbidities (63 matched pairs) were considered. Conclusions: RBCT does not improve the clinical outcome in non-bleeding critically ill patients with moderate anemia. [ABSTRACT FROM AUTHOR]

Let X be the branching particle diffusion corresponding to the operator Lu + β(u2 - u) on D ⊆ Rd (where β ⩾ 0 and β ≢ 0). Let λc denote the generalized principal for the operator L + β on D and assume that it is finite. When λ > 0 and L + β — ̻c satisfies certain spectral theoretical conditions, we prove that the random measure exp (—λct)Xt converges almost surely in the vague topology as t tends to infinity. This result is motivated by a cluster of articles due to Asmussen and Hering dating from the mid-seventies as well as the more recent work concerning analogous results for superdiffusions of [Ann. Prob. 40 (2002) 683-722. Ann Inst. H. Poincaré Probab. Statist. 42 (2006) 171-185]. We extend significantly the results in [Z. Wahrsch. Verw. Gebiete 36 (1976) 195-212. Math. Scand. 39 (1977) 327-342. J. Funct. Anal. 250 (2007) 374-399] and include some key examples of the branching process literature. As far as the proofs are concerned, we appeal to modern techniques concerning martingales and "spine" decompositions or "immortal particle pictures." [ABSTRACT FROM AUTHOR]

Patients suffering from critical illness have host inflammatory responses against injuries, such as infection and trauma, that can lead to tissue damage, organ failure, and death. Modulation of host immune response as well as infection and damage control are detrimental factors in the management of systemic inflammation. The gut is the motor of multiple organ failure following injury, and it is recognized that gut dysfunction is one of the causative factors of disease progression. The gut microbiota has a role in maintaining host immunity, and disruption of the gut microbiota might induce an immunosuppressive condition in critically ill patients. Treatment with probiotics and synbiotics has been reported to attenuate systemic inflammation by maintaining gut microbiota and to reduce postoperative infectious complications and ventilator-associated pneumonia. The administration of prophylactic probiotics/synbiotics could be an important treatment option for preventing infectious complications and modulating immunity. Further basic and clinical research is needed to promote intestinal therapies for critically ill patients. [ABSTRACT FROM AUTHOR]