Application of a computer-assisted structure elucidation program for the structural determination of a new terpenoid aldehyde with an unusual skeleton.

The structure of a novel compound from Adansonia digitata has been elucidated, and its 1 H and 13 C NMR spectra have been assigned employing a variety of one-dimensional and two-dimensional NMR techniques without degradative chemistry. The Advanced Chemistry Development ACD/Structure Elucidator software was important for determining part of this structure that contained a fused bicyclic system with very few hydrogen atoms, which in turn, exhibited essentially no discriminating HMBC connectivities throughout that portion of the molecule. Copyright © 2016 John Wiley & Sons, Ltd.

Robust monitoring of hypovolemia in intensive care patients using photoplethysmogram signals.

The paper presents a fingertip photoplethysmography based technique to assess patient fluid status that is robust to waveform artifacts and health variability in the underlying patient population. The technique is intended for use in intensive care units, where patients are at risk for hypovolemia, and signal artifacts and inter-patient variations in health are common. Input signals are preprocessed to remove artifact, then a parameter-invariant statistic is calculated to remove effects of patient-specific physiology. Patient data from the Physionet MIMICII database was used to evaluate the performance of this technique. The proposed method was able to detect hypovolemia within 24 hours of onset in all hypovolemic patients tested, while producing minimal false alarms over non-hypovolemic patients.

Advancing extubation time for cardiac surgery patients using lean work design.

BACKGROUND: Early extubation in select cardiac surgery patients reduces tracheal intubation times, intensive care unit length of stay, and hospital length of stay. While there is good evidence in the literature to support early extubation, there is very little published research that describes how to study and redesign processes of care to increase early extubation rates. OBJECTIVE: To improve rates of early extubation by redesigning patient care processes using Lean principles to remove barriers to desired care and facilitate early extubation with guideline management. DESIGN: Retrospective data analysis. SETTING: Sixteen-bed intensive care unit in a mid-sized, academic community hospital. PATIENTS: Four hundred four patients undergoing coronary artery bypass graft surgery, aortic valve replacement, or mitral valve replacement/repair. INTERVENTION: The process of care for cardiac surgery patients, beginning with the immediate preoperative period and ending with extubation in the postoperative period, was analyzed using Lean methodologies. A value stream analysis was performed to identify waste in the process, and root causes for the largest sources of waste were identified. Hypothermia on admission to the intensive care unit, prolonged weaning using arterial blood gas results, hypertension management with pain medications and sedation medications, and delays in obtaining equipment were the primary reasons early extubation was delayed. Process redesign using Lean work design principles was implemented to eliminate these issues. MEASUREMENTS: The rate of patients being extubated in fewer than 6 hours and length of intubation. RESULTS: One hundred ninety-five pre-intervention subjects were compared with 171 post-intervention subjects. The pre- and post- groups did not differ in demographic predictors (Table 1). The intervention predicted extubation in<6 hours (pre-intervention 27% versus post-intervention 50%, p = 0.0001). Age, renal failure, and gender also predicted whether intubation occurred within 6 hours. The median length of intubation was lower post-intervention (pre-intervention 9.7 v post-intervention 6.1 hours, p = 0.0019) LIMITATIONS: The effect of this nonrandomized intervention could be due to other factors associated with a different care epoch. CONCLUSIONS: The closely planned, coordinated, and integrated care paradigm dramatically increased the likelihood of extubation within 6 hours of arrival in the SICU.

The effect of ICU telemedicine on mortality and length of stay.

We conducted a retrospective, observational study of patient outcomes in two intensive care units in the same hospital. The surgical ICU (SICU) implemented telemedicine and electronic medical records, while the medical ICU (MICU) did not. Medical charts were reviewed for a one-year period before telemedicine and a one-year period afterwards. In the SICU, records were obtained for 246 patients before and 1499 patients after implementation; in the MICU, records were obtained for 220 patients and 285 patients in the same periods. The outcomes of interest were ICU length of stay and mortality, and hospital length of stay and mortality. Outcome variables were severity-adjusted using APACHE scoring. A bootstrap method, with 1000 replicates, was used to assess stability of the findings. The adjusted ICU length of stay, ICU mortality, and hospital mortality for the SICU patients all decreased significantly after the implementation of telemedicine. There was no change in adjusted outcome variables in the MICU patients. Implementation of telemedicine and electronic records in the surgical ICU was associated with a profound reduction in severity-adjusted ICU length of stay, ICU mortality, and hospital mortality. However, it is not possible to conclude definitively that the observed associations seen in the SICU were due to the intervention.

Blind trials of computer-assisted structure elucidation software.

BACKGROUND: One of the largest challenges in chemistry today remains that of efficiently mining through vast amounts of data in order to elucidate the chemical structure for an unknown compound. The elucidated candidate compound must be fully consistent with the data and any other competing candidates efficiently eliminated without doubt by using additional data if necessary. It has become increasingly necessary to incorporate an in silico structure generation and verification tool to facilitate this elucidation process. An effective structure elucidation software technology aims to mimic the skills of a human in interpreting the complex nature of spectral data while producing a solution within a reasonable amount of time. This type of software is known as computer-assisted structure elucidation or CASE software. A systematic trial of the ACD/Structure Elucidator CASE software was conducted over an extended period of time by analysing a set of single and double-blind trials submitted by a global audience of scientists. The purpose of the blind trials was to reduce subjective bias. Double-blind trials comprised of data where the candidate compound was unknown to both the submitting scientist and the analyst. The level of expertise of the submitting scientist ranged from novice to expert structure elucidation specialists with experience in pharmaceutical, industrial, government and academic environments. RESULTS: Beginning in 2003, and for the following nine years, the algorithms and software technology contained within ACD/Structure Elucidator have been tested against 112 data sets; many of these were unique challenges. Of these challenges 9% were double-blind trials. The results of eighteen of the single-blind trials were investigated in detail and included problems of a diverse nature with many of the specific challenges associated with algorithmic structure elucidation such as deficiency in protons, structure symmetry, a large number of heteroatoms and poor quality spectral data. CONCLUSION: When applied to a complex set of blind trials, ACD/Structure Elucidator was shown to be a very useful tool in advancing the computer's contribution to elucidating a candidate structure from a set of spectral data (NMR and MS) for an unknown. The synergistic interaction between humans and computers can be highly beneficial in terms of less biased approaches to elucidation as well as dramatic improvements in speed and throughput. In those cases where multiple candidate structures exist, ACD/Structure Elucidator is equipped to validate the correct structure and eliminate inconsistent candidates. Full elucidation can generally be performed in less than two hours; this includes the average spectral data processing time and data input.

Bedside nurses' perceptions of intensive care unit telemedicine.

BACKGROUND: Intensive care unit telemedicine is an innovative approach to providing critical care services for a broad geographic area, but its success may depend on acceptance by bedside providers. OBJECTIVES: To determine critical care nurses' attitudes toward and perceptions about the use of telemedicine in critical care. METHODS: A total of 179 nurses in 3 critical care units in 2 university-affiliated academic hospitals that use telemedicine intensivists and nurses were surveyed via the Internet about their practice and perceptions of telemedicine. RESULTS: Among the 93 respondents (response rate, 52%), 72 worked at least 1 night shift and therefore had experience with the telemedicine unit. Reported contact with the telemedicine unit was relatively infrequent: 31% reported being called by the unit 3 or more times in the preceding 6 months. A total of 44% reported regularly incorporating interventions suggested by the telemedicine staff. A majority (72%) thought that telemedicine increases patients' survival, but fewer thought that telemedicine prevents medical errors (47%) or improves the satisfaction of patients' families (42%). Some respondents thought that telemedicine interrupted work flow (9%), was intrusive (11%), or resulted in a feeling of being spied upon (13%). Most nurses thought that personally knowing the telemedicine physician was important (79%), and nurses were more likely to contact the telemedicine unit if they knew the physician on call (61%). CONCLUSIONS: Practicing bedside nurses with experience in telemedicine generally support its use, but concerns about privacy issues and the desire to personally know the telemedicine physician may hinder broader application of the technology.