Bloodstream infection (BSI) is a serious complication of critical illness but it is uncertain whether acquisition of BSI in the intensive care unit (ICU) increases the risk of death. A study was ...conducted among all Calgary health region (population ∼1 million) adults admitted to ICUs for 48 h or more during a three-year period to investigate the occurrence, microbiology and risk factors for developing an ICU-acquired BSI and to determine whether these infections independently predict mortality. One hundred and ninety-nine ICU-acquired BSI episodes occurred during 4933 ICU admissions for a cumulative incidence of 4% and an incidence density of 5.4 per 1000 ICU days. The most common isolates were
Staphylococcus aureus (18%), coagulase-negative staphylococci (11%), and
Enterococcus faecalis (8%); 12% of infections were due to antimicrobial-resistant bacteria. Admission to the regional neurosurgery/trauma ICU odds ratio (OR) 2.86; 95% confidence interval (CI) 2.10–3.90 and increasing Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.05 per point, 95% CI 1.03–1.07) were associated with higher risk, whereas a surgical diagnosis (OR 0.69; 95% CI 0.52–0.93) was associated with lower risk of developing ICU-acquired BSI in logistic regression analysis. The crude in-hospital death rate was 45% for patients with ICU-acquired BSI compared with 21% for those without (
P<0.0001). Development of an ICU-acquired BSI was an independent risk factor for death (OR 1.79; 95% CI 1.3–2.5) and increases the risk of dying from critical illness.
On the basis of an evolutionary theory of self-esteem (SE), it was hypothesized that the SE-aggression relationship differs across functionally distinct domains of SE and across contexts. In 2 ...experiments, participants had the opportunity to aggress against the evaluator of an essay they had written. In Study 1, self-perceived
superiority
was positively related to aggression, whereas
social inclusion
was inversely related to aggression. In Study 2, in which the context was altered to simulate a mating competition, only a measure of self-perceived
mate value
emerged as a (positive) predictor of aggression. Global SE failed to contribute to the prediction of aggression in either experiment. Statistically controlling for narcissism did not eliminate either set of findings. Implications for the conceptualization and measurement of SE and narcissism are discussed.
Abstract Successful cell-based tissue engineering requires a rapid and thorough vascularization in order to ensure long-term implant survival and tissue integration. The vascularization of a scaffold ...is a complex process, and is modulated by the presence of transplanted cells, exogenous and endogenous signaling proteins, and the host tissue reaction, among other influencing factors. This paper presents evidence for the significance of pre-seeded osteoblasts for the in vivo vascularization of a biodegradable scaffold. Human osteoblasts, cultured on silk fibroin micronets in vitro , migrated throughout the interconnected pores of the scaffold and produced extensive bone matrix. When these constructs were implanted in SCID mice, a rapid and thorough vascularization of the scaffold by the host blood capillaries occurred. This profound response was not seen for the silk fibroin scaffold alone. Moreover, when the pre-cultivation time of human osteoblasts was reduced from 14 days to only 24 h, the significant effect these cells exerted on vascularization rate in vivo was still detectable. From these studies, we conclude that matrix and soluble factors produced by osteoblasts can serve to instruct host endothelial cells to migrate, proliferate, and initiate the process of scaffold vascularization. This finding represents a potential paradigm shift for the field of tissue engineering, especially in bone, as traditional strategies to enhance scaffold vascularization have focused on endovascular cells and regarded osteoblasts primarily as cell targets for mineralization. In addition, the migration of host macrophages and multinucleated giant cells into the scaffold was also found to influence the vascularization of the biomaterial. Therefore, the robust effect on scaffold vascularization seen by pre-culturing with osteoblasts appears to occur in concert with the pro-angiogenic stimuli arising from host immune cells.
THE HELLP SYNDROME Kirkpatrick, C. A.
Acta clinica belgica (English ed. Online),
03/2010, Letnik:
65, Številka:
2
Journal Article
Recenzirano
The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10- 20% of ...cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, treatment, mode of delivery and risk of recurrence. Clinical reviews published between 2000 and 2009 were screened using PubMed and Cochrane databases.
About 70% of cases develop before delivery, the majority in the third trimester of pregnancy; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment ( ≥ 48 hours) is controversial. Delivery is indicated if the HELLP syndrome occurs after the 34th week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. In gestational ages between 24 and 34 weeks, a single course of corticosteroid for foetal lung maturation is recommended. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. Close surveillance of the mother should be continued for at least 48 hours after delivery. The recognition of HELLP syndrome and an aggressive multidisciplinary approach and prompt transfer of these women to obstetric centres with expertise in this field are required for the improvement of materno-foetal prognosis.
In this study we sought to address several limitations of previous research on attachment theory and religion by (1) developing a dimensional attachment to God scale, and (2) demonstrating that ...dimensions of attachment to God are predictive of measures of affect and personality after controlling for social desirability and other related dimensions of religiosity. Questionnaire measures of these constructs were completed by a sample of university students and community adults (total n = 374). Consistent with prior research on adult romantic attachment, two dimensions of attachment to God were identified: avoidance and anxiety. After statistically controlling for social desirability, intrinsic religiousness, doctrinal orthodoxy, and loving God image, anxious attachment to God remained a significant predictor of neuroticism, negative affect, and (inversely) positive affect; avoidant attachment to God remained a significant inverse predictor of religious symbolic immortality and agreeableness. These findings are evidence that correlations between attachment to God and measures of personality and affect are not merely byproducts of confounding effects of socially desirable responding or other dimensions of religiosity.
•Of 971 patients with epilepsy, 38% never had reproductive health counseling documented.•Nearly half of patient-years (49%) had no mention of reproductive health counseling.•Menses, folic acid, and ...contraception were each documented in >20% of patient-years.•Pregnancy, teratogens, or sexual activity were documented in <5% of patient-years.•Teratogen use, age, and race/ethnicity were factors associated with counseling.
Rationale
The American Academy of Neurology (AAN) recommends annual sexual and reproductive health (SRH) counseling for all people with epilepsy of gestational capacity (PWEGC). Child neurologists report discussing SRH concerns infrequently with adolescents. Limited research exists regarding documentation of such counseling.
We retrospectively studied clinical notes using natural language processing to investigate child neurologists’ documentation of SRH counseling for adolescent and young adult PWEGC. We segmented notes into sentences and evaluated for references to menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in a labeling application and used machine learning to identify additional counseling instances. We repeated this iteratively until we identified no new relevant sentences. We validated results using external reviewers; after removing sentences reviewers disagreed on (n = 13/400), we calculated Cohen’s kappa values between the model and reviewers (>0.98 for all categories). We evaluated labeled texts for each patient per calendar year with descriptive statistics and logistic regression, adjusting for race/ethnicity, age, and teratogen use.
Data comprised 971 PWEGC age 13–21 years with 2277 patient-years and 3663 outpatient child neurology notes. Nearly half of patient-years lacked SRH counseling documentation (49.1%). Among all patients, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of antiseizure medications that have a higher risk of teratogenic effects (OR = 1.27, p = 0.020, 95% CI = 1.04,1.54; OR = 1.27, p = 0.027, 95% CI = 1.03,1.58). Documentation regarding contraception, folic acid, and sexual activity was increased among older patients (OR = 1.28, p < 0.001, 95% CI = 1.21,1.35; OR = 1.26, p < 0.001, 95% CI = 1.19,1.32; OR = 1.26, p = 0.004, 95% CI = 1.08,1.47). Documentation regarding sexual activity was decreased among patients identifying as White/Non-Hispanic (OR = 0.39, p = 0.007, 95% CI = 0.20,0.78).
Child neurologists counsel PWEGC on SRH less frequently than recommended by the AAN based on documentation.
We present the SDSS-XDQSO quasar targeting catalog for efficient flux-based quasar target selection down to the faint limit of the Sloan Digital Sky Survey (SDSS) catalog, even at medium redshifts ...(2.5 z 3) where the stellar contamination is significant. We build models of the distributions of stars and quasars in flux space down to the flux limit by applying the extreme-deconvolution method to estimate the underlying density. We convolve this density with the flux uncertainties when evaluating the probability that an object is a quasar. This approach results in a targeting algorithm that is more principled, more efficient, and faster than other similar methods. We apply the algorithm to derive low-redshift (z < 2.2), medium-redshift (2.2 <= z <= 3.5), and high-redshift (z>3.5) quasar probabilities for all 160,904,060 point sources with dereddened i-band magnitude between 17.75 and 22.45 mag in the 14,555 deg2 of imaging from SDSS Data Release 8. The catalog can be used to define a uniformly selected and efficient low- or medium-redshift quasar survey, such as that needed for the SDSS-III's Baryon Oscillation Spectroscopic Survey project. We show that the XDQSO technique performs as well as the current best photometric quasar-selection technique at low redshift, and outperforms all other flux-based methods for selecting the medium-redshift quasars of our primary interest. We make code to reproduce the XDQSO quasar target selection publicly available.
Repeater scaling and its impact on CAD Saxena, P.; Menezes, N.; Cocchini, P. ...
IEEE transactions on computer-aided design of integrated circuits and systems,
04/2004, Letnik:
23, Številka:
4
Journal Article
Recenzirano
We study scaling in the context of typical block-level wiring distributions, and identify its impact on the design process. In particular, we study the implications of exponentially increasing ...repeater and clocked repeater counts on the algorithms and methodologies used for physical synthesis and full-chip assembly, showing that mere capacity scaling of current algorithms and methodologies is insufficient to handle the new challenges. Finally, we suggest a few approaches to tackle these challenges by constructing a case for abstract fabrics.
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