Translation and cultural adaptation of the Greek version of the confusion assessment method diagnostic algorithm and the nursing delirium screening scale and their inter-rater reliability: A prospective cohort study.

AIM: The lack of standardized tools limits the diagnosis οf postoperative delirium (POD) in the Greek population. Our aim was the translation and the cultural adaptation of the confusion assessment method (CAM) diagnostic algorithm and the nursing delirium screening scale (nu-DESC) in the Greek surgical population, and the determination of their inter-rater reliability. METHODS: After Ethical approval and registration as a clinical trial (NCT04154176), a prospective cohort study was conducted in the Department of Anesthesiology, University Hospital of Larissa, Greece. Patients at least 60 years old, undergoing elective non-cardiac surgery, under general anesthesia were included. RESULTS: Data from 60 patients, 180 records in total, were analyzed. There was an "almost perfect agreement" between the raters with the use of CAM (Cohen's Kappa estimate: 0.960; 95 % CI: 0.905-1.000) and nu-DESC (Cohen's Kappa estimate: 0.981; 95 % CI: 0.944-1.000). The agreement on each specific question of CAM and nu-DESC ranged from "substantial" to "almost perfect agreement". Based on the CAM, the sensitivity and specificity of nu-DESC were 0.97 (95 % CI: 0.82-1.00) and 0.99 (95 % CI: 0.96-1.00), respectively. The Greek versions of CAM and nu-DESC showed a high inter-rater agreement. CONCLUSION: With the translation, the cultural adaptation, and the determination of their inter-rater agreement, the CAM diagnostic algorithm and the nu-DESC may serve as reliable instruments for the detection of POD in the Greek population. HIPPOKRATIA 2020, 24(1): 8-14.

Scenario planning with linked land-sea models inform where forest conservation actions will promote coral reef resilience.

We developed a linked land-sea modeling framework based on remote sensing and empirical data, which couples sediment export and coral reef models at fine spatial resolution. This spatially-explicit (60 × 60 m) framework simultaneously tracks changes in multiple benthic and fish indicators as a function of land-use and climate change scenarios. We applied this framework in Kubulau District, Fiji, to investigate the effects of logging, agriculture expansion, and restoration on coral reef resilience. Under the deforestation scenario, models projected a 4.5-fold sediment increase (>7,000 t. yr-1) coupled with a significant decrease in benthic habitat quality across 1,940 ha and a reef fish biomass loss of 60.6 t. Under the restoration scenario, models projected a small (<30 t. yr-1) decrease in exported sediments, resulting in a significant increase in benthic habitat quality across 577 ha and a fish biomass gain of 5.7 t. The decrease in benthic habitat quality and loss of fish biomass were greater when combining climate change and deforestation scenarios. We evaluated where land-use change and bleaching scenarios would impact sediment runoff and downstream coral reefs to identify priority areas on land, where conservation or restoration could promote coral reef resilience in the face of climate change.

Distribution of heavy metals in sediment cores of Lake Pamvotis (Greece): a pollution and potential risk assessment.

Concentrations and vertical distributions of metals in surface sediments of Lake Pamvotis (NW Greece) were assessed using energy-dispersive X-ray fluorescence spectrometry. A wide range of values was determined, associated with the specific types of contaminating effluents draining into different parts of the lake. Overall, Cr levels ranged from 43 to 3295 mg kg(-1), Ni from 13 to 372 mg kg(-1), Cu from 15 to 24,985 mg kg(-1), Zn from 129 to 22,983 mg kg(-1), Zr from 64 to 4063 mg kg(-1) and Pb from 19 to 2634 mg kg(-1). Principal component analysis revealed distinct elemental fingerprints in each sampling location, while correlation analysis and hierarchical agglomerative cluster analysis provided insight to metal association and pollution sources. Enrichment factors and geoaccumulation indices were calculated to quantify sediment contamination, and potential ecotoxic effects were evaluated based on sediment quality guidelines. Moderate to very severe enrichment in Zn, Cu and Pb was evidenced in sediments near the lake's outflow. The proximity of these sampling points to a heavy traffic national road suggests that roadway runoff is the dominant source of elevated metal levels. Contribution from municipal sewage water discharges from the nearby communities should also be accounted for. Moderate to very severe Zn and Pb enrichment was determined in the vicinity on the main lake's inflow, primarily associated with runoff and leaching from agricultural land. Very severe to extremely severe Cr enrichment was detected in the same location, most likely associated with wastewater discharged into the lake over several decades, by nearby-operating leather tanneries. The above two locations were ranked at the highest priority level in terms of potential ecological risk.

Environmental measurements and inspections on imported foods and feedstuffs in Greece after the Fukushima accident.

The radionuclides released during the accident at the Fukushima Daichii nuclear power plant following the Tohoku earthquake and tsunami on 11 March 2011 were dispersed in the whole north hemisphere. Traces of (131)I, (134)Cs and (137)Cs reached Greece and were detected in air, grass, sheep milk, ground deposition, rainwater and drainage water. Members of Six Greek laboratories of the national network for environmental radioactivity monitoring have collaborated with the Greek Atomic Energy Commission (GAEC) and carried out measurements during the time period between 11 March 2011 and 10 May 2011 and reported their results to GAEC. These laboratories are sited in three Greek cities, Athens, Thessaloniki and Ioannina, covering a large part of the Greek territory. The concentrations of the radionuclides were studied as a function of time. The first indication for the arrival of the radionuclides in Greece originating from Fukushima accident took place on 24 March 2011. After 28 April 2011', concentrations of all the radionuclides were below the minimum detectable activities (<10 µBq m(-3) for (131)I). The range of concentration values in aerosol particles was 10-520 µBq m(-3) for (131)I, 10-200 µBq m(-3) for (134)Cs and 10-200 µBq m(-3) for (137)Cs and was 10-2200 µBq m(-3) for (131)I in gaseous phase. The ratios of (131)I/(137)Cs and (134)Cs/(137)Cs concentrations are also presented. For (131)I, the maximum concentration detected in grass was 2.2 Bq kg(-1). In the case of sheep milk, the maximum concentration detected for (131)I was 2 Bq l(-1). Furthermore, more than 200 samples of imported foodstuff have been measured in Greece, following the EC directives on the inspection of food and feeding stuffs.

Hybrid procedures for the treatment of multi-focal ipsilateral internal carotid and proximal common carotid or innominate artery lesions.

We report three cases with concomitant ipsilateral proximal common carotid and internal carotid artery stenosis treated in one stage with carotid endarterectomy and retrograde primary stenting of the common carotid artery. The internal carotid artery was clamped during stenting to avoid cerebral embolization. All procedures were successfully completed and all patients remain asymptomatic at 18 months follow up. The one-stage hybrid approach appears to be a safe and effective procedure for the treatment of ipsilateral multifocal significant lesions.

Deconvolution of liquid scintillation alpha spectra of mixtures of uranium and radium isotopes.

A method for the determination of uranium and radium isotopes in water samples is proposed. Liquid scintillation techniques were used for collecting alpha spectra, which were then analyzed by fitting the alpha peaks with overlapping Gaussians. The analysis can quantify the observed isotopes with accuracy depending on the activity of each isotope. In order to simulate the peaks with Gaussian normal distribution functions, the centroid of each peak as well as the full width at half maximum (FWHM) are required, as they depend on the quenching of the sample. For this purpose, samples with known activities of 226Ra and its decay products and also of the uranium isotopes 238U and 234U, at various quenching levels, were used to establish the correlation of the peaks' shift with the quench effect. In addition, the correlation of the FWHM with the centroid of a peak was determined, using the same procedure. Following the above analysis technique, an average of 97+/-2% of detection efficiency and a lower limit of detection of 8.2 mBq kg(-1) for alpha isotopes were achieved.

The impact of fluid restriction policy in reducing the use of red blood cells in cardiac surgery.

Hemodilution contributes significantly to transfusion requirements in patients undergoing CABG under CPB. We hypothesised that restriction of parenteral fluids in comparison to a liberal fluid administration policy leads to less use of packed red cells in CABG operations supported by cell salvage. After consent and approval, 130 patients operated under equal conditions were assigned prospectively and randomly either for a restrictive protocol for intravenous fluid administration (group A, 65 pts) or not (group B, 65 pts). Transfusion guidelines were common for the two groups. The volumes of intravenous fluids, priming, "extra" volume on pump and cardioplegic solution and the volume of urine were recorded. Net erythrocyte volume loss was calculated. The number of the transfused PRC was analyzed as a continuous variable. "Transfusion" was analyzed as a categorical characteristic. Significant difference existed between groups for the fluids administered intravenously until the initiation of CPB and for fluid balance after CPB. Intraoperatively transfused units were significantly lower in A (0.32 +/- 0.77 vs 1.26 +/- 1.05 u/per pt; p<0.0001). Transfused patients were also significantly lower in A (11/65 vs 44/65; p<0.0001). In both groups, the values of hematocrit were statistically decreased. The greatest difference compared to the preoperative values was observed after CPB (from 40.8 +/- 4.2 to 21.9 +/- 3.6 for A, and from 40.2 +/- 3.7 to 19.7 +/- 3.3 for B ; p<0.0001 for both). For these lowest values, significant difference existed between groups (p<0,001) while the difference in the hematocrit values to the end of operation was insignificant. Transfusion in ICU showed no significant difference among groups. Hours of mechanical ventilation in ICU were ranging from 5 to 29 (mean = 10.0, median = 9) for A and from 5 to 42 (mean = 14.8, median = 10) for B. Length of stay in ICU in nights for group A was ranging from 1 to 10 (mean = 2.7, median = 2) and for group B was ranging from 1 to 6 (mean = 3.5, median = 2). In conclusion, reduction of transfusions in CABG operations is feasible when a restrictive protocol for intravenous fluids is applied.

Rapid screening of 90Sr activity in water and milk samples using Cherenkov radiation.

A method for screening 90Sr in milk samples is proposed. This method is based on a liquid scintillation technique taking advantage of Cherenkov radiation, which is produced in a liquid medium and then detected by the photomultipliers of a Liquid Scintillation Counter (LSC). Twenty millilitres of water and milk samples spiked with various concentrations of 90Sr/90Y in equilibrium were added in plastic vials and then were measured with an LSC (TriCarb 3170 TR/SL). The derived efficiencies were 49% for water samples and 14% for milk samples. The detection limit was 470 mBq L(-1)(90)Sr for water, without any pretreatment. Milk contains potassium, which also produces Cherenkov radiation due to the presence of 40K. For this reason, the interference of 40K in the measurements of 90Sr in milk samples was also investigated. The detection limit for milk was 1.7 Bq L(-1)90Sr.

Determination of 226Ra in aqueous solutions via sorption on thin films and alpha-spectrometry.

An improved spectrometric method to determine the 226Ra activity in aqueous solutions is described. The method involves two stages, a preconcentration stage of 226Ra sorption onto a thin manganese layer and a measurement stage using alpha-spectrometry. Manganese oxide thin films were prepared and characterized with X-ray diffraction (XRD) and X-ray fluorescence (XRF) analyses. The thin films were found to follow the XRD patterns and chemical formula of the K-birnessite layered exchanger. The preconcentration of radium was studied relative to the initial radium concentration, pH and salt concentrations. The preconcentration kinetics was studied as a function of manganese surface, solution volume and salt concentration. Extensive Monte Carlo calculations were performed to optimise the detection of alpha-particles. In this way, the thin film preparation procedure as well as the radium sorption and the measurement conditions were optimised and detection limits lower than 0.5 mBq L(-1) were obtained for 2d of procedure completion. The method was validated with IAEA standards and it was applied for the determination of 226Ra in bottled waters and also wastewaters from the major thermoelectric plant in Greece. Moreover, the 226Ra distribution coefficients (K(d)) of two differently prepared powder manganese oxides, a crystalline silicotitanate and an aluminium-pillared montmorillonite were determined by gamma-spectrometry. 226Ra sorption experiments on silicotitanate thin films were performed and improvements in resolution and reduction of exposure time were observed.

Radon activity levels and effective doses in the Perama Cave, Greece.

An investigation of atmospheric radon levels in the Perama Cave, North-western Greece, has been carried out using CR-39 detectors. The detectors were placed at various locations along the guided cave pathway and exposed during different sampling periods. Mean concentrations amounting to 925 +/- 418 and 1,311 +/- 352 Bq m-3 were recorded in the summer and winter months, respectively. As the Perama Cave is one of the most popular in Greece, attracting more than 85,000 tourists per year, the quantification of effective doses to staff and visitors was an issue of importance. Doses less than 5.1 microSv per visit were calculated for tourists and around 1.8 mSv y-1 for seasonal guides, employed for periods of high visiting frequency. The annual exposure of permanent guides was estimated to fall between 3 and 10 mSv, which is the range of action levels recommended by the ICRP.

Soil gas radon: a tool for exploring active fault zones.

The profile of soil gas radon was monitored in five active fault sites in northern and northwestern Greece. Measurements were carried out during summer months, using CR-39 solid state nuclear track detectors (SSNTDs). The spatial distribution of radon along lines traversing the fault zones revealed anomalies, clearly connected to the local tectonic structure. Specifically, increased radon signals evolved on the radon background level, in the vicinity of the faults' axes and the signal-to-background ratio ranged from 2 to 13. The consistency of this pattern confirms that the radon technique is powerful in the detection and mapping of active fault zones.

A survey of 222Rn concentrations in dwellings of the town of Metsovo in north-western Greece.

A radon survey has been carried out of indoor radon concentrations in dwellings located in the town of Metsovo, in north-western Greece. To measure indoor radon concentrations, CR-39 detectors were installed in randomly selected houses and were exposed for about 3 mo, during summer and winter. Gamma spectroscopy measurements of the soil's radium content also were performed. The indoor radon concentration levels varied from 17.6 to 750.4 Bq m(-3), while the radium concentration of soil varied from 4.9 to 97.1 Bq m(-3). Seasonal variation of the radon levels and the influence of house features and soil are discussed.

Strontium-90 concentration measurements in human bones and teeth in Greece.

Strontium-90 concentration was measured in human bones and teeth collected in Greece during the period 1992-1996. One hundred and five bone samples, mainly cancellous bone, and 108 samples, taken from a total of 896 individual teeth were processed. Samples were classified according to the age and sex of the donors. Samples were chemically pre-treated according to a specially devised method to enable extraction of 90Y, at equilibrium with 90Sr in the original sample. Subsequently, 90Y beta activity was measured with a gas proportional counter. Radiostrontium concentration in bone samples showed small variations with respect to age or sex, with an average value of 30 mBq 90Sr/g Ca. However, 90Sr concentration measurements in teeth demonstrated a pronounced structure, which clearly reflects contamination from the 1960s atmospheric nuclear weapons tests and the more recent Chernobyl accident. This difference is attributed to the different histological structure of skeletal bones and teeth, the later consisting mainly of compact bone. An age-dependent model for radiostrontium concentration in human bones and teeth is developed which is able to successfully reproduce the experimental data. Through a fitting process, the model also yielded calcium turnover rates for compact bone, as a function of age, as well as an estimate of radiostrontium contamination of foodstuffs in Greece for the past four decades. The results obtained in this study indicate that radiostrontium environmental contamination which resulted from the atmospheric nuclear weapons tests in the 1960s, exceed by far that caused by the Chernobyl accident.

Facial heliotrope rash as the initial manifestation of acute myelomonocytic leukemia.

The association of leukocytoclastic vasculitis or dermatomyositis with malignancies has been reported. We describe a patient who developed a skin rash, histologically compatible with dermatomyositis, which during the course of the disease switched to leukocytoclastic vasculitis, which was accompanied with peripheral blood pancytopenia in the absence of any specific pathological manifestation from the bone marrow three years prior to the diagnosis of acute myelomonocytic leukemia (AMML).

Reduction of cesium concentration in ovine tissues following treatment with Prussian Blue labeled with 59Fe.

The effectiveness of Prussian Blue in reducing the radiocesium contamination in ovine tissues was investigated. Five ewes were fed 137Cs-contaminated wheat for 30 d. When the 137Cs concentration in milk had reached equilibrium, one animal, serving as the control, was slaughtered and the activity in its tissues was measured. Two ewes were offered daily 1 g of Prussian Blue labeled with 59Fe in the Fe(III) position, outside the complex anion. One week after the administration of Prussian Blue, these animals were slaughtered, 1 wk apart, and the level of 137Cs in their tissues was measured. Comparing the concentration of 137Cs in the blood and tissues of the Prussian Blue treated animals to the corresponding concentrations measured in the control, a considerable reduction in the radiocesium activity concentration is observed. However, 137Cs concentrations are maintained at non-zero (about 20%) values in the first 2 wk after the administration of Prussian Blue. This observation can be attributed to the fact that most of 137Cs binds to Prussian Blue in the animals' digestive tracts and the measured activity concentrations follow the elimination of cesium from tissues. Using a two-compartment mathematical model, we can predict the level of 137Cs in tissue, following the administration of Prussian Blue. Labeling Prussian Blue in the Fe(III)-position resulted in the measurement of a (2.4 +/- 0.02) % retention of Fe(III) in sheep.

Radiostrontium transfer to sheep's milk as a result of soil ingestion.

Soil ingestion as a source of radiostrontium contamination of ruminant milk products was studied by measuring the transfer coefficient to ovine milk. This is a follow-up report from a previous experiment (Assimakopoulos et al., 1993), which investigated radiocaesium transfer to sheep's milk as a result of soil ingestion. Milk samples from three lactating ewes, housed in individual metabolism cages, were used. Fifty grams per day of heavily contaminated sandy topsoil, collected in the Chernobyl area, were administered orally to the animals for a period of 1 week. The daily intake of 90Sr was 78 Bq day-1. During this contamination period, daily milk production and excreta output were measured. Excreta and milk was collected for an additional 7-day decontamination period, while they were fed on uncontaminated feed. The transfer coefficient was obtained through a best fit (minimum chi 2) of the data to predictions of a linear compartment model. The value obtained was fm = 0.041 +/- 0.016 d kg-1 for radiostrontium transport to milk. This result suggests that soil ingestion can be a major source of radiostrontium contamination in sheep and other free-grazing ruminants.