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Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.
The involvement of charge-transfer (CT) states in the photogeneration and recombination of charge carriers has been an important focus of study within the organic photovoltaic community. In this work, we investigate the molecular factors determining the mechanism of photocurrent generation in low-donor-content organic solar cells, where the active layer is composed of vacuum-deposited C-60 and small amounts of organic donor molecules. We find a pronounced decline of all photovoltaic parameters with decreasing CT state energy. Using a combination of steady-state photocurrent measurements and time-delayed collection field experiments, we demonstrate that the power conversion efficiency, and more specifically, the fill factor of these devices, is mainly determined by the bias dependence of photocurrent generation. By combining these findings with the results from ultrafast transient absorption spectroscopy, we show that blends with small CT energies perform poorly because of an increased nonradiative CT state decay rate and that this decay obeys an energy-gap law. Our work challenges the common view that a large energy offset at the heterojunction and/or the presence of fullerene clusters guarantee efficient CT dissociation and rather indicates that charge generation benefits from high CT state energies through a slower decay to the ground state.
Effects of Aerobic and Resistance Exercise on Cardiovascular Parameters for People Living With HIV
(2019)
People living with HIV (PLWH) have limited exercise capacity because of anemia, neuromuscular disorders, and pulmonary limitations. We used a meta-analysis to examine the effect of aerobic and resistance exercise alone and in combination on cardiovascular parameters. Subgroup meta-analyses were conducted and long-term effects of exercise were investigated. A systematic literature search was conducted up to July/August 2017. The Physiotherapy Evidence Database-scale was used to rate quality and assess the risk of bias on the papers. Standardized mean differences (SMDs) were calculated to assess the effect of exercise. Posttreatment comparison between the exercise and control groups revealed moderate and large effect sizes in favor of the intervention group for VO2max (SMD50.66, p < .0001) and the 6-minute walk test (SMD = 1.11, p = .0001). Exercise had a positive effect on cardiovascular parameters in PLWH. Exercise can be a prevention factor for PLWH dealing with multiple comorbidities.
The in-phase response collected by portable loop-loop electromagnetic induction (EMI) sensors operating at low and moderate induction numbers (<= 1) is typically used for sensing the magnetic permeability (or susceptibility) of the subsurface. This is due to the fact that the in-phase response contains a small induction fraction and a preponderant induced magnetization fraction. The magnetization fraction follows the magneto-static equations similarly to the magnetic method but with an active magnetic source. The use of an active source offers the possibility to collect data with several loop-loop configurations, which illuminate the subsurface with different sensitivity patterns. Such multiconfiguration soundings thereby allows the imaging of subsurface magnetic permeability/susceptibility variations through an inversion procedure. This method is not affected by the remnant magnetization and theoretically overcomes the classical depth ambiguity generally encountered with passive geomagnetic data. To invert multiconfiguration in-phase data sets, we propose a novel methodology based on a full-grid 3-D multichannel deconvolution (MCD) procedure. This method allows us to invert large data sets (e.g. consisting of more than a hundred thousand of data points) for a dense voxel-based 3-D model of magnetic susceptibility subject to smoothness constraints. In this study, we first present and discuss synthetic examples of our imaging procedure, which aim at simulating realistic conditions. Finally, we demonstrate the applicability of our method to field data collected across an archaeological site in Auvergne (France) to image the foundations of a Gallo-Roman villa built with basalt rock material. Our synthetic and field data examples demonstrate the potential of the proposed inversion procedure offering new and complementary ways to interpret data sets collected with modern EMI instruments.
Ground-penetrating radar is widely used to provide highly resolved images of subsurface sedimentary structures, with implications for processes active in the vadose zone. Frequently overlooked among these structures are tunnels excavated by fossorial animals (e.g., moles). We present two repeated ground-penetrating radar surveys performed a year apart in 2016 and 2017. Careful three-dimensional data processing reveals, in each data set, a pattern of elongated structures that are interpreted as a subsurface mole tunnel network. Our data demonstrate the ability of three-dimensional ground-penetrating radar imaging to non-invasively delineate the small animal tunnels (similar to 5 cm diameter) at a higher spatial and geolocation resolution than has previously been achieved. In turn, this makes repeated surveys and, therefore, long-term monitoring possible. Our results offer valuable insight into the understanding of the near-surface and showcase a potential new application for a geophysical method as well as a non-invasive method of ecological surveying.