Objectives
To define a set of indicators that could be used to improve quality in intensive care medicine.
Methodology
An European Society of Intensive Care Medicine Task Force on Quality and Safety ...identified all commonly used key quality indicators. This international Task Force consisted of 18 experts, all with a self-proclaimed interest in the area. Through a modified Delphi process seeking greater than 90% consensual agreement from this nominal group, the indicators were then refined through a series of iterative processes.
Results
A total of 111 indicators of quality were initially found, and these were consolidated into 102 separate items. After five discrete rounds of debate, these indicators were reduced to a subset of nine that all had greater than 90% agreement from the nominal group. These indicators can be used to describe the structures (3), processes (2) and outcomes (4) of intensive care. Across this international group, it was much more difficult to obtain consensual agreement on the indicators describing processes of care than on the structures and outcomes.
Conclusion
This document contains nine indicators, all of which have a high level of consensual agreement from an international Task Force, which could be used to improve quality in routine intensive care practice.
The notion that plasma cells (PCs) are terminally differentiated has prevented intensive research in multiple myeloma (MM) about their phenotypic plasticity and differentiation. Here, we demonstrated ...in healthy individuals (n=20) that the CD19-CD81 expression axis identifies three bone marrow (BM)PC subsets with distinct age-prevalence, proliferation, replication-history, immunoglobulin-production, and phenotype, consistent with progressively increased differentiation from CD19+CD81+ into CD19-CD81+ and CD19-CD81- BMPCs. Afterwards, we demonstrated in 225 newly diagnosed MM patients that, comparing to normal BMPC counterparts, 59% had fully differentiated (CD19-CD81-) clones, 38% intermediate-differentiated (CD19-CD81+) and 3% less-differentiated (CD19+CD81+) clones. The latter patients had dismal outcome, and PC differentiation emerged as an independent prognostic marker for progression-free (HR: 1.7; P=0.005) and overall survival (HR: 2.1; P=0.006). Longitudinal comparison of diagnostic vs minimal-residual-disease samples (n=40) unraveled that in 20% of patients, less-differentiated PCs subclones become enriched after therapy-induced pressure. We also revealed that CD81 expression is epigenetically regulated, that less-differentiated clonal PCs retain high expression of genes related to preceding B-cell stages (for example: PAX5), and show distinct mutation profile vs fully differentiated PC clones within individual patients. Together, we shed new light into PC plasticity and demonstrated that MM patients harbouring less-differentiated PCs have dismal survival, which might be related to higher chemoresistant potential plus different molecular and genomic profiles.
We evaluated an essential oil (EO) of Tagetes lucida Cav. and the mixture of its main compounds against multi‐drug resistant bacteria. We found that EO and the partially reconstituted blend of its ...main components have antibacterial activity and inhibit antibiotic resistance (ampicillin, chloramphenicol, nalidixic acid, vancomycin and imipenem) in strains of Staphylococcus aureus ATCC 29213 and Pseudomonas aeruginosa HIM‐MR01. The T. lucida EO alone or added to the antibiotics showed antimicrobial activity against S. aureus and P. aeruginosa. The EO main bioactive compounds were methyl eugenol (relative abundance in EO: 46·15%), estragole (32·93%), linalool (2·48%) and geraniol (0·33%). The mixture (PREO) of those compounds at those proportions inhibited the growth of P. aeruginosa in 45% at 683·62 µg ml−1 and that of S. aureus in 51·7% at 39·04 µg ml−1. The PREO had higher antibacterial and modulatory activities than the original EO. In conclusion, we overcame the unpredictability of EO activity (due to their natural variability) by determining which EO components inhibited bacteria and then producing a PREO to generate a reproducible mixture with predictable antibacterial and modulation of resistance activities. Thus, the PREO, and its components, show potential as alternatives to manage multidrug‐resistant pathogens.
Significance and Impact of the Study: To contribute to fighting antimicrobial resistance to antibiotics, we evaluated an essential oil (EO) of Tagetes lucida and the mixture of its main compounds (PREO) against multi‐drug resistant bacteria. The EO and the PREO have antibacterial activity and modulate antibiotic resistance in Staphylococcus aureus and Pseudomonas aeruginosa. Also, we overcame the natural unpredictability of the EOs activity by determining which EO components inhibited bacteria and then producing a consistent PREO with predictable antibacterial and modulatory antibiotic resistance activity. To our knowledge, this is the first time that this procedure has generated a reconstituted blend with predictable effects from EOs.
ABSTRACT
This study analyzes the spatiotemporal variability of rainfall and temperature (minimum, maximum and average) trends at 47 stations throughout the Brazilian Legal Amazon for the period ...1973–2013. Annual, wet season and dry season trends were quantified by Sen's slope for each station and the entire region. The Mann–Kendall test was used to determine the statistical significance of the trends. For the whole region, minimum, maximum and average annual temperatures showed increasing trend of approximately 0.04 °C per year. The rainfall showed an insignificant trend for most stations for annual and seasonal series. Nevertheless, some stations showed significant increasing trends in the annual and wet season rainfalls while a few stations showed decreasing trends for the dry season rainfall. A positive trend of the annual range between wet and dry season rainfall was found in some stations, caused mainly by an increasing trend in wet season rainfall.
Abstract
Improvements in cost and speed of next generation sequencing (NGS) have provided a new pathway for delivering disease diagnosis, molecular typing, and detection of antimicrobial resistance ...(AMR). Numerous published methods and protocols exist, but a lack of harmonisation has hampered meaningful comparisons between results produced by different methods/protocols vital for global genomic diagnostics and surveillance. As an exemplar, this study evaluated the sensitivity and specificity of five well-established in-silico AMR detection software where the genotype results produced from running a panel of 436
Escherichia coli
were compared to their AMR phenotypes, with the latter used as gold-standard. The pipelines exploited previously known genotype–phenotype associations. No significant differences in software performance were observed. As a consequence, efforts to harmonise AMR predictions from sequence data should focus on: (1) establishing universal minimum to assess performance thresholds (e.g. a control isolate panel, minimum sensitivity/specificity thresholds); (2) standardising AMR gene identifiers in reference databases and gene nomenclature; (3) producing consistent genotype/phenotype correlations. The study also revealed limitations of in-silico technology on detecting resistance to certain antimicrobials due to lack of specific fine-tuning options in bioinformatics tool or a lack of representation of resistance mechanisms in reference databases. Lastly, we noted user friendliness of tools was also an important consideration. Therefore, our recommendations are timely for widespread standardisation of bioinformatics for genomic diagnostics and surveillance globally.
The purpose of this paper is study the fractional-order dynamics of the oxygen diffusion through capillary to tissues under the influence of external forces considering the fractional operators of ...Liouville–Caputo and Caputo–Fabrizio. We apply the Laplace homotopy method for analytical and numerical results. Three cases are considered: first, when axial and radial forces acting on capillary, the second one when only radial force acting on capillary and finally when axial force acting on capillary. In order to validate the importance and application of the presented method with the old and new Caputo fractional order derivatives, we given some examples. The solutions obtained confirm that the Laplace homotopy method is a powerful an efficient technique for analytic treatment of a wide variety of diffusion equations in mathematical physics.
•Fundamental solutions for the oxygen diffusion equation are obtained.•We consider several cases for the effect of radial forces.•New complex dynamics are obtained with the application of several fractional-order derivatives.
Purpose
We performed a survey on acute heart failure (AHF) in nine countries in four continents. We aimed to describe characteristics and management of AHF among various countries, to compare ...patients with de novo AHF versus patients with a pre-existing episode of AHF, and to describe subpopulations hospitalized in intensive care unit (ICU) versus cardiac care unit (CCU) versus ward.
Methods and results
Data from 4,953 patients with AHF were collected via questionnaire from 666 hospitals. Clinical presentation included decompensated congestive HF (38.6%), pulmonary oedema (36.7%) and cardiogenic shock (11.7%). Patients with de novo episode of AHF (36.2%) were younger, had less comorbidities and lower blood pressure despite greater left ventricular ejection fraction (LVEF) and were more often admitted to ICU.
Overall, intravenous (IV) diuretics were given in 89.7%, vasodilators in 41.1%, and inotropic agents (dobutamine, dopamine, adrenaline, noradrenaline and levosimendan) in 39% of cases. Overall hospital death rate was 12%, the majority due to cardiogenic shock (43%). More patients with de novo AHF (14.2%) than patients with a pre-existing episode of AHF (10.8%) (
p
= 0.0007) died. There was graded mortality in ICU, CCU and ward patients with mortality in ICU patients being the highest (17.8%) (
p
< 0.0001).
Conclusions
Our data demonstrated the existence of different subgroups based on de novo or pre-existing episode(s) of AHF and the site of hospitalization. Recognition of these subgroups might improve management and outcome by defining specific therapeutic requirements.
Virtual fieldtrips in palaeontology and geology offer an expanded environment to make field sites more accessible for a broader audience. Based on extensive experience working in upper Neogene ...deposits in the province of Huelva, on the western edge of the Guadalquivir Basin, we have selected 10 sites for their regional palaeontological-geological interest (geosites). By applying geoinformatic tools, we have produced a virtual 3D tour of the georeferenced geosites, integrating multiple thematic digital layers (including geological maps, topographical maps, a digital terrain model and orthophotos). Each stop in the tour contains descriptive and graphic elements that can be viewed in free virtual globes (e.g., Google Earth), combined with diagrams, photographs and information sheets that quantitatively assess the cultural tourism, scientific and educational value of the geosite. From this digital 3D geodatabase, we propose a virtual flight itinerary that can be displayed in compatible video formats and using new technologies, such as smartphones, tablets or iPads.
Objective
To compare the effect of inhaled nitrous oxide (INO) on pain control during in‐office hysteroscopy with 1% lidocaine paracervical infiltration and no analgesic.
Design
Single‐blind ...stratified randomised clinical trial with masked assessment by a third party.
Setting
Department of Obstetrics and Gynaecology in a Spanish hospital.
Population
Women who underwent hysteroscopy.
Methods
Patients were stratified into three groups according to the purpose of the hysteroscopy (biopsy, polypectomy or tubal sterilisation) and then assigned to different treatment groups through a permuted‐blocks randomisation within strata. Pain scale was provided by a gynaecologist totally blinded to procedures and treatments. Effects were assessed using a one‐way analysis of variance following an intention‐to‐treat approach.
Main outcome measures
Visual analogue scale (VAS) from 0 to 100 mm.
Results
A total of 314 women were included: 105 to INO, 104 to 1% lidocaine and 105 to no analgesic. Baseline characteristics were comparable. Mean VAS score after the procedure was 34.7 ± 25.8 mm, 36.1 ± 22.9 mm (P = 1.0) and 47.3 ± 28.2 mm (P = 0.001) for INO, 1% lidocaine and no analgesic, respectively. No adverse events were reported in 91 (86.7%) patients in the INO group compared with 79 (76%) in the 1%‐lidocaine group (P = 0.04) and 85 (81%) in the no‐analgesic group (P = 0.26).
Conclusion
INO was as effective as 1% lidocaine in pain control for in‐office hysteroscopy and was better tolerated. The no‐analgesic group presented the poorer results, so was the least recommended clinical option.
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