Levels In Unit Research Articles

Measurement of sound levels in a neonatal intensive care unit of a tertiary care hospital, Karachi, Pakistan.

High sound levels in the neonatal intensive care unit (NICU) can alter preterm newborn hemodynamics and cause long-term neuro-developmental delays and hearing loss. The study aims to collate data on sound levels in a level IV NICU of a tertiary care hospital, identify the factors associated with them, and compare them with the international standards set by the World Health Organization (WHO), Environmental Protection Agency (EPA), and American Academy of Pediatrics (AAP). We carried out a cross-sectional study in NICU from 8th April 2019 to 30th June 2019. Sound levels were recorded for 480h, using a portable sound meter, the Larson Davis 824. We captured sound levels on alternate days, during different shifts and shift changes and in open pods and single isolation rooms within the NICU. Additionally, we documented the total census, acuity of care, number of staff, number of procedures, and number of items of equipment used. The data was analyzed using t-test, ANOVA, and logistic regression. The average sound level (Leq) and the maximum level (Lmax) recorded were 60.66±2.99dBA and 80.19±2.63dBA, respectively, which exceeds international recommendations. The sound level gradually decreased from morning to night hours. The major increase in sound was observed during nursing shift change. Similarly, a significant increase in sound was observed in open bays compared to isolation rooms. However, no difference in sound levels was recorded during weekdays and weekends. The number of healthcare professionals and the number of procedures performed were strongly associated with an increased noise level. Sound levels in NICU were beyond the safety range and international recommendations. We observed a significant sound increment during morning hours and at the time of nursing shift change. High sound levels were associated with increased number of healthcare workers and bedside procedures in NICU.

Analisis Laporan Keuangan Unit Pengelola Kegiatan Program Nasional Pemberdayaan Masyarakat Mandiri Pedesaan Dalam Pengukuran Profitabilitas

ABSTRACT
 The title that the author proposes in this study is "Financial Statement Analysis in Measuring Profitability Levels in the Rural PNPM Mandiri Activity Management Unit, Cinangka District, Serang Regency". measuring the level of profitability in the PNPM Mandiri Rural Activity Management Unit, Cinangka District, Serang Regency. To discuss the formulation of the problem above, in this study the author uses a descriptive research method, namely a method that describes or solves problems faced in the present. With data collection techniques documentation, interviews, observations, and literature study. With analysis techniques and the ratio of operating profit to business assets, the ratio of the rate of return on investment, and the ratio of economic profitability. The result of this research is the analysis of profitability ratios for 2013 by 3%. So the results of the study can answer the question of research problems, namely that the analysis of financial statements can be used as a tool for management to determine the level of profitability in the PNPM Mandiri Rural Activity Management Unit, Cinangka District, Serang Regency. As for reducing the decrease in the profitability ratio of the PNPM Mandiri Rural Activity Management Unit, Cinangka District, Serang Regency, efforts are made to increase revenue and reduce costs so that an increase in profit is obtained.
 Keywords: financial statement analysis, profitability, PNPM Mandiri Rural

Hybrid Model for Forecasting Indoor CO2 Concentration

Indoor CO2 concentration is considered a metric of indoor air quality that affects the health of occupants. In this study, a hybrid model was developed for forecasting the varying indoor CO2 concentration levels in a residential apartment unit in the presence of occupants by controlling the ventilation rates of a heat recovery ventilator. In this model, the mass balance equation for a single zone as a white-box model was combined with a Bayesian neural network (BNN) as a black box model. During the learning process of the hybrid model, the BNN estimated an aggregated unknown ventilation rate and transferred the estimation to the mass-balance equation. A parametric study was conducted by changing the prediction horizons of the hybrid model from 5 to 15 min, and the forecasting performance of the hybrid model was compared with the stand-alone mass balance equation. The hybrid model showed better forecasting performance than that of the mass balance equation on the experimental dataset for a living room and bedroom. The average MBE and CVRMSE of the hybrid model for the prediction horizon of 15 min were 0.65% and 5.23%, respectively, whereas those of the mass balance equation were 0.99% and 9.30%, respectively.

Hemoglobin A1C as a prognostic factor and the pre-diabetic paradox in patients admitted to a tertiary care medical center intensive cardiac care unit

BackgroundHemoglobin A1C (HbA1c) is a form of glycated hemoglobin used to estimate glycemic control in diabetic patients. Data regarding the prognostic significance of HbA1c levels in contemporary intensive cardiac care unit (ICCU) patients is limited.MethodsAll patients admitted to the ICCU at a tertiary care medical center between January 1, 2020, and June 30, 2021, with documented admission HbA1c levels were included in the study. Patients were divided into 3 groups according to their HbA1c levels: < 5.7 g% [no diabetes mellitus (DM)], 5.7–6.4 g% (pre-DM), ≥ 6.5 g% (DM).ResultsA total of 1412 patients were included. Of them, 974 (69%) were male with a mean age of 67(± 15.7) years old. HbA1c level < 5.7 g% was found in 550 (39%) patients, 5.7–6.4 g% in 458 (32.4%) patients and ≥ 6.5 g% in 404 (28.6%) patients. Among patients who did not know they had DM, 81 (9.3%) patients had high HbA1c levels (≥ 6.5 g%) on admission. The crude mortality rate at follow-up (up to 1.5 years) was almost twice as high among patients with pre-DM and DM than in patients with no DM (10.6% vs. 5.4%, respectively, p = 0.01). Interestingly, although not statistically significant, the trend was that pre-DM patients had the strongest association with mortality rate [HR 1.83, (95% CI 0.936–3.588); p = 0.077].ConclusionsAlthough an HbA1c level of ≥ 5.7 g% (pre-DM & DM) is associated with a worse prognosis in patients admitted to ICCU, pre-DM patients, paradoxically, have the highest risk for short and long-term mortality rates.

Elevated Sound Levels in the Neonatal Intensive Care Unit: What Is Causing the Problem?

Premature and sick neonates may require weeks of hospitalization in a noisy neonatal intensive care unit (NICU) environment with sound levels that may reach 120 decibels. The American Academy of Pediatrics recommends a maximum sound level of 45 decibels. To measure sound levels in a level III NICU and to describe contributing environmental factors. Descriptive quantitative study. Sound levels were measured using a portable sound meter in an open-bay level III NICU. Contributing environmental factors were recorded and analyzed. Mean sound levels for day, evening, and night shifts were 83.5, 83, and 80.9 decibels, respectively. Each period of time exceeded the recommended guidelines 90% of the time and was almost double the American Academy of Pediatrics' recommendation. Multiple linear regression findings demonstrated significant factors associated with elevated sound levels including number of neonates, number of people, number of alarms, acuity level, and shift type. Observational data explain 14.5% of elevated sound levels. An understanding of baseline sound levels and contributing environmental factors is the first step in developing strategies to mitigate excessive noise in the NICU. Research should focus on effective and sustainable ways to reduce sound levels in the NICU, including inside the isolette, in order to provide an environment that is conducive to optimal growth and neurodevelopment for preterm and sick infants.

Comparative Analysis of the Nurse Cultural Competency Levels in Inpatient Rooms, Outpatient and Emergency Unit of Regional General Hospital dr. Haryoto Lumajang

Cultural diversity affects individual beliefs and understanding of treatment situations, influencing the treatment process. As care providers, nurses must deliver culturally sensitive care, so cultural competence is paramount. Cultural competence is a crucial element of cross-cultural care. Nevertheless, research on assessing nurses’ cultural competence across different care settings is lacking. This study was aimed to analyze differences in nurses’ cultural competence in inpatient, outpatient, and emergency rooms. The study used a non-experimental quantitative design with a cross-sectional approach conducted on 108 nurses in inpatient, outpatient, and emergency rooms. Data were collected using a Cultural Competence Assessment Instrument (CCAI) questionnaire. The data analysis used univariate and bivariate analysis. Descriptive analysis and the Kruskal Wallis test were used to analyze the data, with p&lt;0.05. The analysis results documented no significant difference in cultural competence among the nurses, evidenced by p 0.841. Their cultural competence was not significantly related to the type of nursing service provided. However, cultural competence is dependent on nurses’ cultural knowledge and organizational support related to the provision of cultural competence training.

Noise levels in the dialysis unit and its relationship with sleep quality and anxiety in patients receiving HD: A pilot study.

HD unit is a noisy environment for patients, and noise can affect anxiety levels and sleep quality. The aim of the study is to determine noise level, the relationship between noise levels, and sleep quality and anxiety in patients in HD unit. A descriptive and observational study design was used. Three Benetech GM1351 manual sound-level meters were used to measure noise. A patient information form, the State Anxiety Inventory, and the modified Post-Sleep Inventory were used for data collection. The noise range detected in the HD unit ranges from 48.40 to 72 dB(A). Our findings show that patients in the HD unit are exposed to high noise levels and the noise significantly negatively impacts quality of sleep and anxiety level of the patients. It is important to be aware that HD patients are constantly exposed to high levels of noise and to plan nursing interventions to reduce this noise level.

Risk Factors Associated with Suboptimal Tobramycin Levels in the Medical Intensive Care Unit.

Optimal aminoglycoside dosing in critically ill patients represents a challenge for practitioners, especially in the medical intensive care unit (MICU). MICU patients exhibit altered pharmacokinetics due to pathophysiological changes the body undergoes in critical illness, leading to possible treatment failure. The literature surrounding optimal dosing and therapeutic drug monitoring strategies of aminoglycosides in MICU patients is scarce and conflicting. Additionally, only a few studies have investigated risk factors for suboptimal pharmacokinetic target obtainment. Currently, no definitive risk factors have been identified to predict suboptimal aminoglycoside target obtainment in MICU patients. The objective of this study was to determine risk factors for suboptimal pharmacokinetic target obtainment in patients receiving tobramycin in the MICU. This single-center, retrospective cohort study included patients 18-89 years old who received at least one 7 mg/kg tobramycin dose in the MICU from January, 1 2015 to September, 30 2020. Patients also had to have at least two detectable drug levels obtained at least one half-life apart following the first tobramycin dose. The primary outcome was to determine the incidence of optimal pharmacokinetic target obtainment, defined as a tobramycinmaximum concentration (Cmax)≥10 mcg/ml, and to identify the risk factors for suboptimal (Cmax < 10 mcg/mL) pharmacokinetic target obtainment, in MICU patients. Secondary outcomes were compared between suboptimal and optimal target obtainment in patients with culture confirmed gram-negative infection susceptible to tobramycin. These secondary outcomes included all-cause in-hospital mortality, ICU length of stay (LOS), hospital LOS, and vasopressor duration in those with shock. A total of 230 patients were included in this retrospective study. For the primary outcome, 187 (81.3%) patients achieved optimal target obtainment. Through multivariate logistic regression, female sex and serum albumin <2.5 g/dL were identified as independent risk factors for suboptimal target obtainment; [OR = 2.14; 95% CI (1.05-4.37), p = 0.037], [OR = 2.50; 95% CI (1.21-5.19), p = 0.014], respectively. Fifty-four (23%) patients had culture-confirmed gram-negative infections susceptible to tobramycin and were included in the subgroup analysis. Of these 54 patients, 11 (20.4%) did not achieve optimal target concentrations. In patients with culture-confirmed gram-negative infection, there was no difference between patients with optimal target obtainment and suboptimal target obtainment in ICU LOS, hospital LOS, all-cause mortality, or vasopressor duration in those with shock. Among patients receiving their first dose of tobramycin in the MICU, 81.3% obtained an optimal serum concentration. Female sex and serum albumin <2.5 g/dL were identified as risk factors for suboptimal target obtainment; however, further research is warranted to assess the utility of using these two covariates as risk factors for more aggressive dosing in critically ill MICU patients.

Decreasing Plasma Fibrinogen Levels in the Intensive Care Unit Are Associated with High Mortality Rates In Patients With Sepsis-Induced Coagulopathy.

Plasma fibrinogen levels increase in response to infection, but they could also decrease due to degradation as in severe coagulopathy. We evaluated 60 septic patients with their CRP levels over 5.00 mg/dL. The patients were classified into three groups based on the ratio of the maximum or minimum fibrinogen concentration within day 3 to the initial concentration on day 0: down-, flat, and uptrend groups (n = 15, 30, and 15, respectively). Both down- and flat trend groups showed reduced inflammatory markers on day 3, and the degree of platelet loss (103/μL) and the mortality rate (%) were more remarkable in the downtrend group ( − 108 vs − 42 [p = 0.026] and 46.7 vs 10.0 [p = 0.027]). On day 0, in total 12 and 9 patients were diagnosed with non-overt DIC in the down- and uptrend groups, of which 5 (41.7%) and 1 (11.1%) died within 28 days after admission. In conclusion, decreasing fibrinogen levels in the ICU are associated with high mortality in patients with sepsis followed by decreasing platelet counts, even when they are diagnosed with non-overt DIC.

Inferential control of the phosphate concentration in hydroponic systems via measurement of the nutrient solution's pH-buffering capacity

Urban hydroponics is expanding on a global scale. This provides environmentalists with an ideal opportunity to couple sustainability principles to the development of the sector. A primary concern in hydroponics is the generation of large amounts of nutrient laden wastewater. Unlike conventional agriculture, the water effluent typically exits the urban farm via a dedicated outlet, where water quality can be monitored and regulated. It is therefore imperative to develop processes in which the quality of the exit water is part of the design objective. Minimisation of nitrogen and phosphorous in the effluent is key in this regard. This study presents an affordable technique to control phosphate levels in a hydroponic unit. The technique relies solely on continuous pH measurement from which the pH-buffering capacity of the nutrient solution is calculated. The pH-buffering capacity is then used as an inferential measurement to control the phosphate concentration in solution. This concentration can then be controlled at significantly lower levels and thereby reduce phosphate spillage proportionally. Experiments were performed in which the phosphate concentration was controlled at 1 ±0.08 mM (representing standard protocol), 0.2 ±0.03 mM and 0.1 ±0.03 mM. No significant variation in plant growth rate or leaf mass fraction was observed in the runs with lower phosphate concentrations, suggesting that optimal growth is possible at phosphate levels ten times lower than conventional practice. Since the phosphate concentration in the hydroponic outlet is directly proportional to the load of phosphate spillage, the results are encouraging from a nutrient pollution perspective.

Sound in Time: An observational study to identify the sources of sound and their relative contribution to the sound environment of an intensive care unit

BackgroundThere is a growing body of research that identifies sound levels in an intensive care unit to be higher than current recommendations; although the quality and reproducibility of these studies has been questioned. Noise is generated by the multiplicity of supportive equipment necessary for patient management and by the staff who provide or enable care. Patients remember noise as a prominent and sometimes distressing feature of their intensive care admission. There is currently no study that provides a robust description of the sources of noise in an intensive care unit. Therefore, the aim of this study was to identify the sources of sound and their relative contribution to the sound environment of an intensive care unit. MethodsFifty hours of observational data were collected over a month, using a datasheet designed and piloted for this purpose. Data was collected at four bed spaces, providing equal representation across each bed space, hour of the day and day of the week. A priori, five categories of sound were identified, communication, clinical tasks, housekeeping tasks, alarms and miscellaneous; 55 individual sources of sound were reported under these categories. Concurrently, continuous sound pressure levels were monitored at each bed space. Results16,784 episodes of sound were identified during the 50hrs of data collection; the greatest number of episodes were reported in the communication category n = 5699 (34%), with clinical tasks n = 3282 (20%), housekeeping tasks n = 3247 (19%), alarms n = 2939 (18%) and miscellaneous n = 1617 (10%). The highest number of episodes for an individual sound source was nurse/nurse communication n = 1595 (10%), followed by bin lids n = 1004 (6%) and oxygen/nebulisers n = 945 (6%). Of the 55 sources recorded, the top 25 accounted for 86% of the episodes. The average SPL (LAeq50hrs) across all bed-spaces during this study was 65.1 dB (SD 3.98) with little variation between day (66.3 dB; SD 3.37) and night time (62.7 dB; SD 3.81), The four bed spaces demonstrated difference in average LAeq, with the nosiest being the single room (LAeq12hrs69.1 dB, SD 1.98); and the quietest bed space 5 in an open bay (LAeq13hrs59.8 dB, SD 2.49). ConclusionConcurrent observational and quantitative data collection enabled detailed analysis of the sound environment. The results provide greater clarity than previous study, into the individual sound sources and their relative contribution to the noise environment of an intensive care unit. This information will help identify which sources of sound are most amenable to modification. There is a need for further study to understand the perception of noise in an intensive care unit, by its main users; the patients, staff and visitors. Current SPL guidance appears unachievable without a change in ambient sound levels.

Plasma NfL trajectory during ICU‐treatment of COVID‐19 patients: A prospective cohort study

BackgroundCOVID‐19 is a respiratory disease where neurological sequelae are frequently reported. Neurofilament light (NfL) in plasma is a validated biomarker for neuronal damage. We assessed the trajectory of NfL levels in intensive care unit (ICU) patients diagnosed with COVID‐19, and studied its relationship to clinical outcomes and markers of hypothesized pathophysiological mechanisms.MethodAs part of the Art‐Deco study and Amsterdam UMC COVID‐biobank, longitudinal samples and clinical data were collected weekly from a cohort of 31 prospectively admitted ICU patients with a minimum of 7 days of ventilation. The mean±sd age was 63±11 years. Admission duration ranged from 14‐35 days and 156 samples were collected. We evaluated the NfL trajectory over time, and whether this trajectory differed by 90‐day mortality outcome. Due to the non‐linear trajectory of NfL, we applied linear mixed models including cubic splines for the time variable. Secondly, we tested whether baseline or peak NfL levels predicted mortality (n=7/31), delirium incidence after detubation (n=18/22), and duration of delirium (6±6 days). Third, we assessed if disease severity (day 7 Sequential Organ Failure Assessment [SOFA] score) and baseline hypoxemia (pAO2 before intubation), inflammation (IL1‐b, IL‐6, IL‐8, TNF‐α), and coagulopathy (d‐dimer, presence of pulmonary embolism) were predictive of the NfL trajectory. For the latter models, we included an interaction term for the pathophysiological markers in the linear mixed models. All models were adjusted for age.ResultNfL increased during ICU admission (p<001), and persisted longer in the non‐survivors (p<0.05;Figure 1). Baseline or maximum NfL was not predictive of mortality or delirium incidence. However, maximum NfL correlated to the duration of delirium (r=0.5;p=0.02). From the pathophysiological markers, SOFA scores (p<0.05) and baseline TNF‐α (p<0.05) were related to a stronger increase of NfL over time.ConclusionNfL levels increased over time and plateaued after 2‐3 weeks in most COVID‐19 patients at the ICU. Peak levels of NfL were predictive of delirium persistence. Repeated NfL levels may provide a future method for monitoring neurological outcomes in sedated ICU patients. Disease severity and specific inflammatory components appear important predictors of the NfL trajectory reflecting axonal damage in severe COVID‐19 patients.

The effect of structured virtual patient visits (sVPVs) on COVID‐19 patients and relatives' anxiety levels in intensive care unit

To determine the effect of structured Virtual Patient Visits (sVPVs) on the anxiety, satisfaction, hospital anxiety and depression levels of intensive care unit (ICU) COVID-19 patients and their relatives. There is no evidence regarding the direct effect of virtual patient visits in the ICU. The STROBE statement guided this study. This investigator-initiated, prospective and single-centre study included COVID-19 patients and their relatives in an adult ICU between July and December 2020. We implemented daily sVPVs between all patients and their relatives. The study's primary outcome was the daily anxiety levels of patients and relatives immediately before and after sVPVs. The secondary outcomes were as follows: 1) hospital anxiety (HADS-A) and depression (HADS-D) levels during admission to and after discharge from the ICU and 2) satisfaction levels regarding the ICU and sVPVs of patients' relatives. A total number of 301 daily sVPVs were conducted between 50 patients and their relatives. There was a significant difference between daily anxiety levels before and after sVPVs in both patients (2.97 vs. 1.49) and their relatives (5.70 vs. 3.53; p>.05). Whereas the anxiety levels of patients with basic face or high flow nasal cannula and non-invasive mechanical ventilation decreased statistically significantly more than those with IMV after a sVPV (p<.001), there was not a significant difference in decreased anxiety levels of patients' relatives according to the type of respiratory support provided to the patient (p>.05). HADS-A levels of relatives decreased statistically significantly after discharge/death. There was no statistically significant difference in HADS-A and HADS-D levels after discharge/death between the relatives of patients who died or did not die (p>.05). Furthermore, the overall ICU satisfaction rates were statistically significantly lower in relatives of patients who died than those who did not die (p<.05). Regardless of whether the patients were intubated, sVPVs reduced the anxiety levels of all patients and relatives. The sVPV programme offered emotional support to patients and family members, with high levels of satisfaction, as well as provided regular informative updates and the opportunity for daily visits or final goodbyes. The sVPV programme is essential for all ICUs during the COVID-19 pandemic.

Low FXIII activity levels in intensive care unit hospitalized COVID-19 patients

BackgroundCOVID-19 infection is associated with a hypercoagulable state. Severe COVID-19 patients present with high plasma fibrinogen levels, continuous deposition of fibrin and the presence of microthrombi in their lungs, accompanied by significant fibrinolysis, resulting in high D-dimer levels. Due to the role of FXIII in fibrin crosslinking and clot stabilization, we analyzed its activity levels and dynamics in COVID-19 patients hospitalized in the intensive care unit (ICU).MethodsFXIII levels were measured in thirty four COVID-19 patients hospitalized in the ICU and in fourteen non-severe COVID-19 patients. FVIII levels were measured for comparison. Laboratory data and clinical variables were recorded.ResultsThe average FXIII activity level in 34 ICU hospitalized COVID-19 patients was 69.9±33 %, significantly lower compared to an average of 120±20.9 % FXIII activity in 14 non-severe COVID-19 patients. FXIII activity levels were below the low normal value (< 79 % FXIII activity) in 74 % of the ICU hospitalized COVID-19 patients. In contrast, high FVIII activity was measured among all severe COVID-19 patients. Consecutive measurements, performed in fourteen ICU hospitalized COVID-19 patients, pointed to a significant decrease in FXIII activity from the average of 85.7±28.2 %, (which is in the normal range), to an average of 68.0±20.4 %, below the low normal range, within 6.4±3.4 days of ICU hospitalization. Liver functions did not differentiate between patients with low and normal FXIII activity. No inhibitor to FXIII activity was found in the plasma of severe COVID-19 patients. Levels of FXIII-A antigen correlated with FXIII activity, and were low in severe COVID-19 patients.ConclusionsLow FXIII activity levels were found in COVID-19 patients hospitalized in the ICU, with gradual decline during their hospitalization. A mechanism of consumption may account for the low FXIII activity in these patients.

Effect of Selected Antidepressants on Placental Homeostasis of Serotonin: Maternal and Fetal Perspectives.

Depression is a prevalent condition affecting up to 20% of pregnant women. Hence, more than 10% are prescribed antidepressant drugs, mainly serotonin reuptake inhibitors (SSRIs) and selective serotonin and noradrenaline reuptake inhibitors (SNRIs). We hypothesize that antidepressants disturb serotonin homeostasis in the fetoplacental unit by inhibiting serotonin transporter (SERT) and organic cation transporter 3 (OCT3) in the maternal- and fetal-facing placental membranes, respectively. Paroxetine, citalopram, fluoxetine, fluvoxamine, sertraline, and venlafaxine were tested in situ (rat term placenta perfusion) and ex vivo (uptake studies in membrane vesicles isolated from healthy human term placenta). All tested antidepressants significantly inhibited SERT- and OCT3-mediated serotonin uptake in a dose-dependent manner. Calculated half-maximal inhibitory concentrations (IC50) were in the range of therapeutic plasma concentrations. Using in vitro and in situ models, we further showed that the placental efflux transporters did not compromise mother-to-fetus transport of antidepressants. Collectively, we suggest that antidepressants have the potential to affect serotonin levels in the placenta or fetus when administered at therapeutic doses. Interestingly, the effect of antidepressants on serotonin homeostasis in rat placenta was sex dependent. As accurate fetal programming requires optimal serotonin levels in the fetoplacental unit throughout gestation, inhibition of SERT-/OCT3-mediated serotonin uptake may help explain the poor outcomes of antidepressant use in pregnancy.

Newborn Incubators Do Not Protect from High Noise Levels in the Neonatal Intensive Care Unit and Are Relevant Noise Sources by Themselves.

Background: While meaningful sound exposure has been shown to be important for newborn development, an excess of noise can delay the proper development of the auditory cortex. Aim: The aim of this study was to assess the acoustic environment of a preterm baby in an incubator on a newborn intensive care unit (NICU). Methods: An empty but running incubator (Giraffe Omnibed, GE Healthcare) was used to evaluate the incubator frequency response with 60 measurements. In addition, a full day and night period outside and inside the incubator at the NICU of the University Hospital Zurich was acoustically analyzed. Results: The fan construction inside the incubator generates noise in the frequency range of 1.3–1.5 kHz with a weighted sound pressure level (SPL) of 40.5 dB(A). The construction of the incubator narrows the transmitted frequency spectrum of sound entering the incubator to lower frequencies, but it does not attenuate transient noises such as alarms or opening and closing of cabinet doors substantially. Alarms, as generated by the monitors, the incubator, and additional devices, still pass to the newborn. Conclusions: The incubator does protect only insufficiently from noise coming from the NICUThe transmitted frequency spectrum is changed, limiting the impact of NICU noise on the neonate, but also limiting the neonate’s perception of voices. The incubator, in particular its fan, as well as alarms from patient monitors are major sources of noise. Further optimizations with regard to the sound exposure in the NICU, as well as studies on the role of the incubator as a source and modulator, are needed to meet the preterm infants’ multi-sensory needs.

Monitoring sound levels in the intensive care unit: A mixed-methods system development project to optimize design features for a new electronic interface in the healthcare environment

BackgroundIntensive care units (ICU) are busy round the clock and it is difficult to maintain low sound levels that support patient rest. To help ICU staff manage activities we developed a visual display that monitors and reports sound levels in real-time. This facilitates immediate feedback, encouraging proactive behavior change to limit disturbances. MethodsFollowing the principles of user-centered design practices we created our ‘user persona’ to understand the needs and goals of potential users of the system. We then conducted iterative user testing with current members of the ICU team, primarily using the ‘think aloud’ method to refine the design and functionality of our novel system. Ethnography evaluated team use of the display. ResultsThe final design was simple, clear, and efficient, and both functional and aesthetically pleasing for the key user demographic. We identified challenges in the implementation and adoption process that were separate from the ‘usability’ of the system itself. ConclusionsEmbedding the design process within the core user demographic ensured the final product delivered relevant information for key users, and that this information was intuitive to interpret. Initiating sustainable change is not straightforward. It requires recognition of cultural practices within teams, departments, professions, organizations, and strategies to maximize engagement.

Prediction of Unbound Vancomycin Levels in Intensive Care Unit and Nonintensive Care Unit Patients: Total Bilirubin May Play an Important Role.

BackgroundThe mean unbound vancomycin fraction and whether the unbound vancomycin level could be predicted from the total vancomycin level are still controversial, especially for patients in different groups, such as intensive care unit (ICU) versus non-ICU patients. Other relevant potential patient characteristics that may predict unbound vancomycin levels have yet to be clearly determined.MethodsWe enrolled a relatively large study population and included widely comprehensive potential covariates to evaluate the unbound vancomycin fractions in a cohort of ICU (n=117 samples) and non-ICU patients (n=73 samples) by using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method.ResultsThe mean unbound vancomycin fraction was 45.80% ± 18.69% (median, 46.01%; range: 2.13–99.45%) in the samples from the total population. No significant differences in the unbound vancomycin fraction were found between the ICU patients and the non-ICU patients (P=0.359). A significant correlation was established between the unbound and total vancomycin levels. The unbound vancomycin level can be predicted with the following equations: unbound vancomycin level=0.395×total vancomycin level+0.019×total bilirubin level+0.468 (R2=0.771) for the ICU patients and unbound vancomycin level=0.526×total vancomycin level-0.527 (R2=0.749) for the non-ICU patients. Overall, the observed-versus-predicted plots were acceptable.ConclusionA significant correlation between the total and unbound vancomycin levels was found, and measurement of the unbound vancomycin level seems to have no added value over measurement of the total vancomycin level. The study developed parsimonious equations for predicting the unbound vancomycin level and provides a reference for clinicians to predict the unbound vancomycin level in adult populations.

Serum Neurofilament Light Chain Levels in the Intensive Care Unit: Comparison between Severely Ill Patients with and without Coronavirus Disease 2019.

There is emerging evidence for multifarious neurological manifestations of coronavirus disease 2019 (COVID-19), but little is known regarding whether they reflect structural damage to the nervous system. Serum neurofilament light chain (sNfL) is a specific biomarker of neuronal injury. We measured sNfL concentrations of 29 critically ill COVID-19 patients, 10 critically ill non-COVID-19 patients, and 259 healthy controls. After adjusting for neurological comorbidities and age, sNfL concentrations were higher in patients with COVID-19 versus both comparator groups. Higher sNfL levels were associated with unfavorable short-term outcome, indicating that neuronal injury is common and pronounced in critically ill patients. ANN NEUROL 2021;89:610-616.

Postoperative anesthesia for vitreoretinal surgery in children

Vitreoretinal surgery for retinal detachments in children is an effective, sometimes the only method to restore vision. As practice shows, the use of minimally invasive regional techniques is increasingly used for combined anesthesia in ophthalmic surgery in children. In the postoperative period, the use of blockades can provide prolonged analgesia, thereby improving the childs comfort level after the surgery. All types of blockades in ophthalmology have certain risks, but the pterygopalatine blockade has not any, since it is performed outside the eye structures. The research of the use of the pterygopalatine blockade after surgery in children is important not only for creating prolonged analgesia, but also for reducing vegetative reactions that can complicate the recovery period.&#x0D; Purposeof the study isto increase the pain management efficacy in the postoperative period in children who have undergone extensive surgery for retinal detachment.&#x0D; Materials and methods. 1st group (n= 32) received postoperative analgesia pterygopalatine blockage with ropivacaine 0.5%, 2nd group (n= 28) systemic analgesia. Changes in hemodynamics and stress index in the postoperative period were evaluated. Cortisol levels in the intensive care unit was evaluated in 2 hours later. The time and frequency use of antiemetics in the occurrence of PONV were recorded. The level of patients comfort after surgery and the pain intensity were evaluated on an integral scale and on the Verbal Rating Scale (VRS) in points.&#x0D; Results.The children of 1st group did not have significant changes in heart rate and SBP in the intensive care unit. In group 1, the TI decreased by 13.2% in the intensive care unit, and in group 2, the TI increased by 28.5% after 2 hours and by 88.6% after 8 hours. 2 hours after the surgery pain was 2 points in 12.5% of the patients (1st group) and 39.2% of patients (2nd group). After 8 hours, 35.7% of patients (2nd group) reported moderate pain that required medication. There were no PONV in group 1, and it occured in 28.5% of patients in group 2. In group 1, 75% of children rated the postoperative period as comfortable, and in group 2 21.4% (p 0,05).&#x0D; Conclusion. Pterygopalatine blockade as the main method of postoperative analgesia in the early postoperative period has got a long-term analgesic effect, reducing the frequency of nausea and vomiting, improving the quality of the postoperative period in children.