Abstract Purpose Critically ill patients who develop sepsis may be at a higher risk of venous thromboembolism (VTE) prophylaxis failure, however, studies in this population are limited. The objective ...of this study was to identify the incidence of VTE prophylaxis failure in this population. Methods This retrospective review of patients admitted to the intensive care unit (ICU) between February 2013 and September 2015 included patients who were diagnosed with sepsis and received heparin or enoxaparin VTE prophylaxis. Results Of the 355 patients included, 42 (12.5%) developed a VTE. Acute respiratory distress syndrome (ARDS) (31% vs 16.7%, P = .0272) and higher positive end expiratory pressure (10 vs 8, P = .0066) were associated with increased risk of VTE prophylaxis failure. Logistic regression identified ARDS an event risk factor (OR 2.58, 95% CI 1.22–5.42). VTE was associated with an increased ICU (14 vs 9 days, P = .01) and hospital length of stay (26 vs 15 days, P < .0001). The median time from sepsis diagnosis to VTE event was 9 days (IQR 5–13). Conclusion Critically ill patients with sepsis had a high rate of VTE prophylaxis failure with ARDS being identified as a risk factor for VTE prophylaxis failure.
Thrombocytopenia in the intensive care unit (ICU) is a commonly experienced complication; the pathology is not always easily understood. Continuous renal replacement therapy (CRRT) provides a method ...to dialyze unstable critically ill patients. We hypothesized that CRRT may precipitate a form of thrombocytopenia. In trials thrombocytopenia occurred at rates as high as 70%. The etiology remains unknown and results in additional diagnostic workup, as well as possible drug therapy. The extent, duration and temporal relation of thrombocytopenia remain to be determined.
Identify a pattern in platelet fluctuations after the initiation of CRRT and its impact on health care.
A retrospective study was conducted in patients receiving CRRT for >24 h with no pre-existing thrombocytopenia. Patients initiated on CRRT had daily platelet counts monitored, and CRRT attributes and therapeutic interventions were collected. Platelets were assessed for time to nadir, degree of decline and time to return to baseline after discontinuation of CRRT.
Forty-nine patients met inclusion criteria. Thirty-seven percent of patients receiving heparinoids were tested for heparin-induced thrombocytopenia (HIT), during CRRT, with 39% of these patients having therapy changed to non-heparinoid agents due to suspected HIT; no HIT antibodies were positive. Eleven patients (22%) receiving anticoagulants, prophylactically or therapeutically had them held for a drop in platelets. There was a mean decline in platelets of 48% with a mean of 4.6 days to the nadir. An average 2.48 days were observed until rebound to >150 × 10(3)/mm(3). Statistical analysis failed to identify any patient attributes that correlated with the probability of thrombocytopenia.
CRRT appears to be associated with a drop in platelets within the first 5 days of therapy with an average decline of 48%. However, platelets appear to return to >150 × 10(3)/mm(3) after cessation of CRRT. This fluctuation should be considered in the setting of patients developing thrombocytopenia after initiation of CRRT.
High-Velocity Collisions of Nanodiamond Johnson, Donald F; Mullin, Jonathan M; Mattson, William D
Journal of physical chemistry. C,
01/2017, Letnik:
121, Številka:
2
Journal Article
Recenzirano
Nanodiamond (ND) is a unique material that exhibits interesting surface properties and is capable of storing strain energy. Molecular dynamics simulations using density functional theory were ...performed on a variety of ND particles, some of which were constructed to specifically incorporate internal strain. The unstrained spherical ND structures were carved out of bulk crystals and relaxed, while the ND with built-in internal strain were constructed as a dense core (compressive strain) encompassed by a thin shell (tensile strain). Both on-axis and off-axis collisions were simulated at 10 km/s relative velocity. Impact energy was enough to partially melt and shatter the ND particles. Upon impact, the outer shell was ruptured and the release of the strained core energy accelerated expansion compared to previous work on bulk-like ND particles. The internal strain also led to greater fragmentation and an increase in the number of reactive surfaces.
Pelagic species of Sargassum, surface drifting macroalgae, occur in continental shelf and deep basin waters across the Gulf of Mexico (GOM). They often accumulate in mats and “windrows” to form a ...structured habitat that serves as a source of food and refuge for a diverse assemblage of fish and invertebrates. Long-term temporal data on the distribution and abundance of Sargassum species in the GOM are lacking, but there is a time series of occurrence of those species across the U.S. GOM (USGOM) associated with ichthyoplankton surveys conducted by the Southeast Area Monitoring and Assessment Program. The seasonal presence of Sargassum species in regions of the USGOM was compared under contrasting weather-related hydrographic regimes using nonparametric tests (Kruskal–Wallis H test, Mann–Whitney U test, Wilcoxon signed rank test). Phases of the Atlantic Multidecadal Oscillation (AMO) and North Atlantic Oscillation (NAO) along with El Niño–Southern Oscillation (ENSO) events influenced seasonal presence of Sargassum species across the area of study. Occurrence of Sargassum species was highest under the coupled warm AMO and neutral NAO phases and cold ENSO events and was associated with physical and biological processes that transported the macroalgae to the USGOM and maintained them over time.
Ab initio molecular dynamics simulations at 300 K, based on density functional theory, are performed to study the hydration shell geometries, solvent dipole, and first hydrolysis reaction of the ...uranium(IV) (U4+) and uranyl(V) (UO2 +) ions in aqueous solution. The solvent dipole and first hydrolysis reaction of aqueous uranyl(VI) (UO2 2+) are also probed. The first shell of U4+ is coordinated by 8–9 water ligands, with an average U–O distance of 2.42 Å. The average first shell coordination number and distance are in agreement with experimental estimates of 8–11 and 2.40–2.44 Å, respectively. The simulated EXAFS of U4+ matches well with recent experimental data. The first shell of UO2 + is coordinated by five water ligands in the equatorial plane, with the average UOax and U–O distances being 1.85 Å and 2.54 Å, respectively. Overall, the hydration shell structure of UO2 + closely matches that of UO2 2+, except for small expansions in the average UOax and U–O distances. Each ion strongly polarizes their respective first-shell water ligands. The computed acidity constants (pK a) of U4+ and UO2 2+ are 0.93 and 4.95, in good agreement with the experimental values of 0.54 and 5.24, respectively. The predicted pK a value of UO2 + is 8.5.
This study examined the role and impact of forensic evidence on case‐processing outcomes in a sample of 4205 criminal cases drawn from five U.S. jurisdictions. Regression analyses demonstrated that ...forensic evidence played a consistent and robust role in case‐processing decisions. Still, the influence of forensic evidence is time‐ and examination‐dependent: the collection of crime scene evidence was predictive of arrest, and the examination of evidence was predictive of referral for charges, as well as of charges being filed, conviction at trial, and sentence length. The only decision outcome in which forensic evidence did not have a general effect was with regard to guilty plea arrangements. More studies are needed on the filtering of forensic evidence in different crime categories, from the crime scene to its use by investigators, prosecutors, and fact‐finders, and to identify factors that shape decisions to collect evidence, submit it to laboratories, and request examinations.
PURPOSEDespite evidence that older women have quality-of-life outcomes similar to younger women after postmastectomy breast reconstruction (PMBR), they rarely receive it. There is a perception that ...PMBR in older women may result in significant physical morbidity. However, the effects of age on physical morbidity after PMBR have not been studied. This study sought to assess perceptions of recovery from surgery and long-term chest and upper body morbidity in older women who receive PMBR.
METHODSWomen with American Joint Committee on Cancer stage 0-III breast cancer who underwent a mastectomy with PMBR between 2005 and 2011 were surveyed to assess their functional health status (DUKE), physical well-being (BREAST-Q), and perceptions of recovery from surgery. Patients were stratified into 2 age groupsolder (≥65 years) and younger (<65 years). Outcome scores were compared by mastectomy laterality, reconstruction type, and between age groups. Data were analyzed using χ and t tests.
RESULTSOne hundred eight older and 103 younger patients returned surveys (response rate, 75.4%). The median time from mastectomy to survey was 4 years (range, 1–7). Younger women were more likely to undergo bilateral mastectomy than older women (65.7% vs 32.2%, P < 0.001). Some women (66.9%) underwent implant-only reconstruction and 33.1% underwent autologous reconstruction; there were no significant differences in reconstruction type between age groups. Patients who underwent unilateral and bilateral mastectomy had similar mean BREAST-Q physical well-being scores (79.4 vs 78.9, respectively, P = 0.85). There was no difference in mean physical well-being scores between older and younger patients (80.0 vs 78.5, respectively, P = 0.61). In addition, older patients were less likely to perceive their recovery from PMBR as being difficult than younger patients, though this was not statistically significant (48.2% vs 64.3%, P = 0.07).
CONCLUSIONSOlder women who undergo PMBR have physical and upper body well-being that is similar to younger women. In addition, their perception of recovery from PMBR is at least as good as that seen in younger women. Older women contemplating PMBR should be counseled that they are not at higher risk for long-term physical and upper body morbidity from PMBR than are younger women.
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