Please select the eligibility criteria that correspond to the clinical trial below.
Title: Dynamic Light Application to Prevent ICU Acquired Delirium
Brief Summary: Rationale: Delirium is a frequently encountered problem in ICU patients and leads to increased morbidity and mortality; Delirium in the ICU is associated with sleep deprivation which is among others caused by a disrupted circadian rhythm; Dynamic Light application aims at restoring a proper circadian rhythm by rhythmically alternating light intensity and has shown beneficial effects in sleep quality. Whether DLA improves sleep quality and reduces delirium incidence in ICU patients is not known

Goals/endpoints:

To evaluate the feasibility of dynamic light application in the ICU and to study the effects of dynamic light application on the incidence of delirium, duration of mechanical ventilation, the number of ICU and hospital days, and mortality in a mixed population of medical and surgical ICU patients. In a subgroup of patients with a high risk of developing delirium, markers of circadian rhythm, inflammation and brain damage and post ICU HRQoL will be assessed Study design: prospective randomized single centre trial Study population: adult ICU patients \> 18 years old with an expected duration of stay of more than 24 hours Intervention: Patients will be randomized between Standard Care or Standard Care + DLA; When receiving standard care, normal lighting settings will be used in that patient room, which can be controlled by the medical personnel; In the rooms of patients randomized to the DLA group, DL is applied with a changing intensity during the day according to a fixed rhythm, which is regulated centrally. In addition when necessary, an intervention light can be used which can be operated in the patient room.

Study parameters/endpoints: incidence of delirium as measured by the CAM-ICU; duration of mechanical ventilation, ICU and total hospital mortality; ICU and hospital LOS; Serum levels of inflammatory markers and markers of brain damage, urinary levels of markers of circadian rhythm, data of HRQoL questionnaires and total light exposure in both groups


Options:
A: Inclusion Criteria:

* Patients between the ages of 4 and 21 years who are enrolled on SJMB03 and to be admitted for either Course 2 or Course 3 of high dose chemotherapy and stem cell rescue.
* English - speaking and able to understand English items on the study instruments as these are only available in English.
* Patients willing to give assent to participate in the study and whose parents are willing to give permission according to institutional guidelines for their child to participate.

Exclusion Criteria:

* Inability or unwillingness of research participant or legal guardian/representative to give written informed consent.
* Patients experiencing serious neurological effects such as posterior fossa syndrome that interfere with their ability to self-report on fatigue and mood.
* Patient is bedridden and unable to participate in an activity.
* Patients or parents who would find participating in the consent process too emotionally demanding as determined by the treatment team.
B: Inclusion Criteria:

* PICU patient at Oishei Children's Hospital of Buffalo
* \>4 years of age, \<18 years of age
* Patients with RASS of +1

Exclusion Criteria:

* Documented underlying psychological disorders
* Diagnosed with sever developmental delay
* Prior narcotic dependence
* Underlying medical conditions affecting heart rate, blood pressure, or neuromuscular system
* Chemically paralyzed patients
* Anyone with an aneurysm
* Patients who are deaf in both ears
* Ear bone fractures or other middle/inner ear trauma or major ear avulsion as determined by physician
* Hemodynamically unstable patients
* Patients facing imminent death
C: Inclusion Criteria:

* ICU-patients \>18 yrs old
* expected duration of stay \> 24 hrs

Exclusion Criteria:

* life expectancy of \<48 hrs on ICU admission
* necessity of prolonged deep sedation
* blindness
* inability to speak or understand dutch
D: Inclusion Criteria:

* Child aged 6-17 admitted to the PICU of one Canadian, university teaching hospital
* Child in age-appropriate grade at school (+- 1 year)
* Child can read and speak English or French
* Parent or primary caregiver willing to participate in the intervention, who can read, speak and write English or French

Exclusion Criteria:

* Child diagnosed with a sleep disorder, seizure disorder, hearing disorder, or who has had neurological surgery that precludes sleep measurement
* Child expected to die during their PICU stay

Answer: C