CORA
Cork Open Research Archive (CORA) is UCC’s Open Access institutional repository which enables UCC researchers to make their research outputs freely available and accessible.
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Are the Charlson and Elixhauser comorbidity indices reliable predictors of postoperative delirium in abdominal surgery?
(Elsevier BV, 2026-09-01) Chorney, Wesley; Lisi, Michael
Background: Postoperative delirium (POD) is a common complication of surgery. It is associated with a number of detrimental effects, including mortality and healthcare costs. We sought to determine whether common comorbidity indices are predictors of POD.
Methods: Using the Medical Information Mart for Intensive Care (MIMIC)-IV database, we identified 8022 abdominal surgery procedures across 7212 adult patients. We calculated both the Charlson comorbidity index (CCI) and the Elixhauser comorbidity index (ECI) for each procedure and used logistic regression to predict postoperative delirium, which was defined as delirium within 30 days following the procedure.
Results: Models based on either the CCI and ECI were predictive of postoperative delirium (area under the receiver-operator characteristic curve (AUC-ROC) of 0.622 and 0.652, respectively). However, the addition of other factors known to be associated with delirium improved model performance (AUC-ROC of 0.680).
Conclusion: Both the CCI and ECI are predictors of postoperative delirium in patients undergoing abdominal surgery. Addition of factors known to be associated with delirium renders additional predictive value and should be included in models that predict postoperative delirium.
Pediatric infectious encephalitis in Spain: etiology, outcomes, and acyclovir use in emergency departments
(Wolters Kluwer, 2026-10-14) García Bailo, Celia; Alonso-Cadenas, José Antonio; Cantarín, Verónica; Bidaurrazaga García, Klaudia Irati; Velasco, Roberto; Calvo Cillán, Alicia; Borrull Senra, Ana María; López Fernández, Cristina; Olaciregui Echenique, Izaskun; Méndez Sánchez, Alejandra; Campo Fernández, Nathalie; Collazo Vallduriola, Iris; González Abad, María; de la Iglesia Rivaya, Ana; Escolà Morales, Laura; Figueroa Jiménez, Sara; Valle T-Figueras, Inés; Gómez, Borja
Background:
Pediatric infectious encephalitis remains a significant cause of neurologic morbidity. Prompt antiviral treatment is recommended in patients with suspected herpes simplex virus (HSV) encephalitis. This study aimed to describe the epidemiology and outcomes of infectious encephalitis and to evaluate acyclovir use in children with suspected encephalitis presenting to the pediatric emergency department (PED).
Methods:
We conducted a multicenter, retrospective, cross-sectional study involving 10 Spanish PEDs (2017–2023), including children ≤18 years who underwent cerebrospinal fluid polymerase chain reaction testing as part of the evaluation of a possible central nervous system infection. Patients meeting the International Encephalitis Consortium (IEC) criteria for infectious encephalitis were analyzed, and acyclovir prescription rates were assessed.
Results:
We registered 446 episodes; 118 patients (26.5%) met the IEC criteria, and 88 (74.6%) had microbiologic confirmation. The most common pathogens were enterovirus (43.2%), influenza virus (18.2%) and HSV (9.0%). Thirty-seven patients (31.4%) had an adverse outcome, including 75% of those with HSV infection. Acyclovir was administered to 56.9% and 53.1% of patients with and without an altered mental status, respectively. All patients meeting IEC criteria presented with altered mental status and ≥1 minor criterion at evaluation in the PED.
Conclusions:
Enteroviruses were the leading cause of pediatric infectious encephalitis, whereas HSV infection was associated with the highest risk of adverse outcomes. Acyclovir use in the PED was suboptimal and poorly aligned with clinical criteria. Our findings suggest that empirical acyclovir should be considered in patients with altered mental status and at least one minor criterion, whereas it may be unnecessary in the absence of these features.
Bipedicled deep inferior epigastric perforator flap reconstruction in necrotising fasciitis following implantable contraceptive device insertion
(Elsevier BV, 2026-05-09) Msellati, Augustin; Christodoulides, Natasha; Dorairaj, Jemima
Summary: Necrotising Fasciitis (NF) is a severe infection leading to the destruction of muscle fascial compartments and overlying soft tissue. These infections arise following the direct disruption to one’s skin integrity, with large proportion of these infections due to group A streptoccous (GAS). These infections often lead to extensive tissue defects rendering reconstruction challenging.
This report looks at the first recorded case of necrotising fasciitis following insertion of an implantable contraceptive device. In this case of GAS NF, reconstruction with a bipedicled deep inferior epigastric perforator flap was performed to achieve coverage of a large soft tissue defect of the left upper limb. This method of reconstruction allowed for complete coverage of the wound, despite its extensive size, all while providing good function of the limb and an aesthetically pleasing result.
Diagnostic challenges in pediatric infectious encephalitis: applicability of the international encephalitis consortium criteria and prognostic factors in a multicenter study
(Wolters Kluwer, 2026-10-19) García Bailo, Celia; Alonso-Cadenas, José Antonio; Cantarín, Verónica; Bidaurrazaga García, Klaudia Irati; Velasco, Roberto; Calvo Cillán, Alicia; Borrull Senra, Ana María; López Fernández, Cristina; Olaciregui Echenique, Izaskun; Méndez Sánchez, Alejandra; Campo Fernández, Nathalie; Collazo Vallduriola, Iris; González Abad, María; de la Iglesia Rivaya, Ana; Escolà Morales, Laura; Figueroa Jiménez, Sara; Valle T-Figueras, Inés; Gómez, Borja
Background:
The International Encephalitis Consortium (IEC) criteria are widely used to diagnose pediatric encephalitis, although their performance has not been evaluated.
Objective:
To evaluate IEC criteria in children with suspected encephalitis and identify prognostic factors associated with adverse outcomes.
Methods:
Secondary analysis of a retrospective multicenter study including children aged <18 years undergoing cerebrospinal fluid polymerase chain reaction testing for suspected encephalitis in 10 Spanish Pediatric Emergency Departments between 2017 and 2023. Patients were classified according to the IEC criteria. Children fulfilling the major criterion and 1 minor criterion plus pathogen confirmation were classified as subthreshold encephalitis. Multivariable logistic regression was used to identify prognostic factors for adverse outcomes.
Results:
Of 446 children, 118 met IEC criteria (60 confirmed, 15 probable, 43 possible encephalitis). Twenty additional cases were classified as subthreshold encephalitis. Rates of adverse outcomes were similar in both groups (31.4% vs. 30.0%). Independent predictors of adverse outcomes were abnormal neuroimaging (adjusted odds ratio [aOR], 3.2; 95% confidence interval [CI], 1.6–6.4; P < 0.001), focal neurologic deficits (aOR, 2.6; 95% CI, 1.3–5.2; P = 0.01), bacterial etiology (aOR, 2.7; 95% CI, 1.05–6.8; P = 0.03), seizures (aOR, 2.1; 95% CI, 1.0–4.5; P = 0.04) and microbiologic confirmation (aOR, 1.9; 95% CI, 1.0–3.6; P = 0.048).
Conclusions:
Children with altered mental status and an encephalitis-associated pathogen but only 1 minor IEC criterion may represent missed encephalitis cases. Microbiologic confirmation, particularly bacterial etiology, and 3 minor IEC criteria were independently associated with worse outcomes, with abnormal neuroimaging being the strongest predictor.
Bio-inspired semi-submersible platform for improving the hydrodynamic stability of floating vertical-axis wind turbines
(Elsevier B.V., 2026-08-15) Liu, Kunpeng; Huang, Haoda; Liu, Qingsong; Zhang, Qiang; Li, Chun; Iglesias, Gregorio; Wang, Jin; Bashir, Musa; Horizon Europe, 101204880; UK Research and Innovation, UKRI, TS/Y005236/1-TS/X018407/1-TS/Y006364/1; National Key Research and Development Program of China, NKRDPC, 2024YFA1012500; National Natural Science Foundation of China, NSFC, 52376204; Liverpool John Moores University, LJMU; University of Liverpool, UoL
Floating vertical axis wind turbines (VAWTs) offer high power density, directional insensitivity and convenient operation and maintenance; however, their large power fluctuations and limited survivability under extreme sea states hinder utility-scale deployment. To address these challenges, this study proposes a water hyacinth (WH)-inspired semi-submersible platform incorporating biomimetic buoyancy chambers parameterized using Bézier curves. Three configurations (WHS, WHM, and WHL) are developed and evaluated using a Dynamic Fluid-Body Interaction (DFBI) approach coupled with a Volume of Fluid (VOF) model under combined wind-wave loading. The biomimetic geometry modifies the added-mass distribution, hydrodynamic damping, and local flow structures around the platform, leading to reductions of up to 16.3%, 15.5%, and 15.0% in the dominant surge, heave, and pitch responses, respectively. Among the three configurations, WHM exhibits the most balanced hydrodynamic performance. Further comparisons with spherical, cylindrical, and disc-shaped buoyancy structures of equivalent volume demonstrate that the improved stability originates from the biomimetic morphology rather than buoyancy enhancement alone. When integrated into a floating VAWT system, the WHM platform reduces surge, heave, and pitch responses by 0.8%, 11%, and 10%, respectively, while decreasing the power spectral density of the power coefficient by approximately 18.6%. Overall, the proposed WH-inspired platform provides an effective passive strategy for improving the hydrodynamic stability and smoothing power output of floating VAWTs.