Introduction
Diversity has become a key-strategic element of success in various political and economic fields. The European Society of Intensive Care Medicine (ESICM) decided to make diversity a key ...strategic priority for the future and appointed a Task-Force on this topic.
Methods
In a consensus process, three Working-Groups, nominated by Task-Force members, developed statements on strategic future topics. In addition, diversity-related data available from the membership database have been analyzed and reported in aggregated form.
Results
The Task-Force decided to nominate working groups on (1) “sex, gender identity and sexual orientation”, (2) “ethnicity, culture and socio-economic status”, and (3) “multiprofessionalism”. These are the first prioritized topics for the near future. The first diversity-report shows targetable items in all three domains.
Conclusion
The diversity Task-Force defined actionable items for a one- and three-year plan that are especially aiming at the identification of potential gaps and an implementation of concrete projects for members of the ESICM.
Context. Blazars are astrophysical sources whose emission is dominated by non-thermal processes, i.e. synchrotron and inverse Compton emission. Although the general picture is rather robust and ...consistent with observations, many aspects are still unexplored. Aims. Polarimetric monitoring can offer a wealth of information about the physical processes in blazars. Models with largely different physical ingredients can provide almost indistinguishable predictions for the total flux, but usually are characterized by different polarization properties. We explore the possibility to derive structural information about the emitting regions of blazars by means of a joint analysis of rapid variability of the total and polarized flux at optical wavelengths. Methods. Short timescale (from tens of seconds to a couple of minutes) optical linear polarimetry and photometry for two blazars, BL Lacertae and PKS 1424+240, was carried out with the PAOLO polarimeter at the 3.6 m Telescopio Nazionale Galileo. Several hours of almost continuous observations were obtained for both sources. Results. Our intense monitoring allowed us to draw different scenarios for BL Lacertae and PKS 1424+240, with the former characterized by intense variability and the latter practically constant in total flux. Essentially the same behavior is observed for the polarized flux and the position angle. The variability time-scales turned out to be as short as a few minutes, although involving only a few percent variation of the flux. The polarization variability time-scale is generally consistent with the total flux variability. Total and polarized flux appear to be essentially uncorrelated. However, even during our relatively short monitoring, different regimes can be singled out. Conclusions. No simple scenario is able to satisfactorily model the very rich phenomenology exhibited in our data. Detailed numerical simulations show that the emitting region should be characterized by some symmetry, and the inclusion of turbulence for the magnetic field may constitute the missing ingredient for a more complete interpretation of the data.
Recent work suggests that increased plasma concentrations of cardiac troponin I (cTnI) are common in critically ill patients and are associated with poor outcome. We measured the frequency of ...increased plasma cTnI concentrations during patients' stay in a mixed medical/surgical intensive care unit (ICU) and compared our findings with hospital mortality.
Basic details, organ support, and hospital mortality were recorded for all patients treated in ICU during a 6 month period. cTnI concentrations were sampled daily for all patients, using 0.04 µg litre−1 as the upper limit of normal, and 0.12 µg litre−1 as an additional stratification point.
Of 663 patients, 54% were male, with a mean (sd) age of 60 (18) yr, 65% were surgical patients, and the median Acute Physiology and Chronic Ill Health II (APACHE II) score was 15 (inter-quartile range 12–20). Increased cTnI concentrations were found in 345 patients (52%) while in ICU. One hundred and twenty patients (18%) died in hospital. cTnI concentration >0.04 µg litre−1 was associated with reduced odds of hospital survival, independent of age, medical admission, unplanned admission, APACHE II score, mechanical ventilation, and haemofiltration (adjusted odds ratio 0.25, 95% confidence interval 0.08–0.75, P=0.014). Stratification by the degree of cTnI increase revealed an incremental trend towards a lower odds of hospital survival, including for patients with ‘minor' elevations of cTnI (0.05–0.12 µg litre−1).
Increased serum cTnI concentrations during ICU stay independently predicts hospital mortality, even when the threshold is low. We found a trend towards an association between ‘minor' elevations in cTnI and higher in-hospital mortality.
Emergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency ...laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume ≤8 ml kg−1 ideal body weight−1, PEEP >5 cm H2O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO2, and peak inspiratory pressure) and the occurrence of PPCs.
Data were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition.
Data were collected from 568 patients. The median inter-quartile range (IQR) tidal volume observed was 500 ml (450–540 ml), corresponding to a median tidal volume of 8 ml kg−1 ideal body weight−1 (IQR: 7.2–9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of <30 cm H2O was protective against development of PPCs (hazard ratio=0.46; confidence interval: 0.30–0.72; P=0.001). Median FiO2 was 0.5 (IQR: 0.44–0.53), and an increase in FiO2 by 5% increased the risk of developing a PPC by 8% (2.6–14.1%; P=0.008).
Both intraoperative peak inspiratory pressure and FiO2 are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes.
The Tempio della Consolazione in Todi (16th cent.) has always been one of the most significant symbols of the Umbrian landscape. Since the first times after its completion (1606) the structure has ...exhibited evidences of instability, due to foundation subsiding and/or seismic activity. Structural and geotechnical countermeasures have been undertaken on the Tempio and its surroundings from the 17th century until recent times. Until now a truly satisfactory analysis of the overall deformation and attitude of the building has not been performed, since the existing surveys record the overhangs of the pillars, the crack pattern or the subsidence over limited time spans. Describing the attitude of the whole church is in fact a complex operation due to the architectural character of the building, consisting of four apses (three polygonal and one semicircular) covered with half domes, which surround the central area with the large dome. The present research aims to fill the gap of knowledge with a global study based on geomatic techniques for an accurate 3D reconstruction of geometry and attitude, integrated with a historical research on damage and interventions and a geotechnical analysis. The geomatic survey results from the integration of different techniques: GPS-GNSS for global georeferencing, laser scanning and digital photogrammetry for an accurate 3D reconstruction, high precision total station and geometric leveling for a direct survey of deformations and cracks, and for the alignment of the laser scans. The above analysis allowed to assess the dynamics of the cracks occurred in the last 25 years by a comparison with a previous survey. From the photographic colour associated to the point cloud was also possible to map the damp patches showing on the domes intrados, mapping their evolution over the last years.
As part of our radial velocity planet-search survey performed with SARG at TNG, we monitored the components of HD 132563 for ten years. It is a binary system formed by two rather similar solar type ...stars with a projected separation of 4.1 arcsec, which corresponds to 400 AU at the distance of 96 pc. The two components are moderately metal-poor (Fe/H = –0.19), and the age of the system is about 5 Gyr. We detected RV variations of HD 132563B with period of 1544 days and semi-amplitude of 26 m/s. From the star characteristics and line profile measurements, we infer their Keplerian origin. Therefore HD 132563B turns out to host a planet with a projected mass msini = 1.49 MJ at 2.6 AU with a moderately eccentric orbit (e = 0.22). The planet around HD 132563B is one of the few that are known in triple stellar systems, as we found that the primary HD 132563A is itself a spectroscopic binary with a period longer than 15 years and an eccentricity higher than 0.65. The spectroscopic component was not detected in adaptive-optics images taken with the instrument AdOpt mounted at the TNG, since it expected at a projected separation that was smaller than 0.2 arcsec at the time of our observations. A small excess in K band difference between the components with respect to the difference in V band is compatible with a companion of about 0.55 M⊙. A preliminary statistical analysis of when planets occur in triple systems indicate a similar frequency of planets around the isolated component in a triple system, components of wide binaries and single stars. There is no significant iron abundance difference between the components. The lack of stars in binary systems and open clusters showing strong enhancements of iron abundance, which are comparable to the typical metallicity difference between stars with and without giant planets, agrees with the idea that accretion of planetary material producing iron abundance anomalies over 0.1 dex is rare.
Assays of cardiac troponin have become a cornerstone in the diagnosis of myocardial infarction across a broad range of clinical settings. In critically ill patients, cardiac troponin is detectable in ...the plasma in up to 60% of cases, and this incidence may increase further as assays become more sensitive. Troponin rises in critical care are commonly unrelated to pathology in the coronary arteries, but are frequently associated with conditions such as sepsis and respiratory failure. Such non-coronary troponin release is a significant, independent predictor of poor patient outcomes, and can be incorporated into risk scoring systems. Despite adding prognostic value, treatment for non-coronary troponin rises remains limited to management of the underlying cause, and restoration of a favourable balance between myocardial oxygen demand and supply. Conversely, troponin rises secondary to myocardial infarctions are amenable to the same interventions as in any other setting, albeit with additional diagnostic and therapeutic challenges. In this review, we will explore the utility of troponin as a biomarker in critical care, and we will outline a pragmatic management strategy for this patient population.
Abstract Immune dysregulation, Polyendocrinopathy, Enteropathy X-linked (IPEX) syndrome is a unique example of primary immunodeficiency characterized by autoimmune manifestations due to defective ...regulatory T (Treg) cells, in the presence of FOXP3 mutations. However, autoimmune symptoms phenotypically resembling IPEX often occur in the absence of detectable FOXP3 mutations. The cause of this “IPEX-like” syndrome presently remains unclear. To investigate whether a defect in Treg cells sustains the immunological dysregulation in IPEX-like patients, we measured the amount of peripheral Treg cells within the CD3+ T cells by analysing demethylation of the Treg cell-Specific-Demethylated-Region (TSDR) in the FOXP3 locus and demethylation of the T cell-Specific-Demethylated-Region (TLSDR) in the CD3 locus, highly specific markers for stable Treg cells and overall T cells, respectively. TSDR demethylation analysis, alone or normalized for the total T cells, showed that the amount of peripheral Treg cells in a cohort of IPEX-like patients was significantly reduced, as compared to both healthy subjects and unrelated disease controls. This reduction could not be displayed by flow cytometric analysis, showing highly variable percentages of FOXP3+ and CD25+ FOXP3+ T cells. These data provide evidence that a quantitative defect of Treg cells could be considered a common biological hallmark of IPEX-like syndrome. Since Treg cell suppressive function was not impaired, we propose that this reduction per se could sustain autoimmunity.
Hemodynamic resuscitation is considered a cornerstone of the initial treatment of septic shock. However, there is growing concern about its side effects. Our objective was to assess the relationship ...between fluid administration and norepinephrine infusion and the development of lung injury.
Randomized in vivo study in rabbits.
University animal research laboratory.
Eighteen New Zealand rabbits. Control group (SHAM, n=6), Sepsis group with or without hemodynamic resuscitation (ETX-R, n=6; ETX-NR, n=6).
Sepsis was induced by intravenous lipopolysaccharide administration and animals were followed-up for 4h. Hemodynamic resuscitation with Ringer lactate (20mL·kg
) was administered and later norepinephrine was initiated 3h after sepsis induction. At the end, the left lung was excised.
An indwelling arterial catheter and an esophageal Doppler were placed. Lung mechanics were monitored with side stream spirometry. Lung damage was analyzed by histopathological examination.
The SHAM group did not show hemodynamic or respiratory changes. Lipopolysaccharide administration aimed an increase in cardiac output and arterial hypotension. In the ETX-NR group, animals remained hypotensive until the end of the experiment. Resuscitation with fluids and norepinephrine reversed arterial hypotension. Compared to the ETX-NR group, the remaining lung of the ETX-R group showed greater accumulation of neutrophils and reactive type-II pneumocytes, thicker alveolar wall, alveolar hemorrhage and non-aerated pulmonary areas. Lung injury score was larger in the ETX-R group.
In our experimental study, following a strategy with bolus fluids and late norepinephrine used in the early phase of endotoxic septic shock has a negative influence on the development of lung injury.
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