Polymyxin B hemoperfusion reduces blood endotoxin levels in sepsis. Endotoxin activity can be measured in blood with a rapid assay. Treating patients with septic shock and elevated endotoxin activity ...using polymyxin B hemoperfusion may improve clinical outcomes.
To test whether adding polymyxin B hemoperfusion to conventional medical therapy improves survival compared with conventional therapy alone among patients with septic shock and high endotoxin activity.
Multicenter, randomized clinical trial involving 450 adult critically ill patients with septic shock and an endotoxin activity assay level of 0.60 or higher enrolled between September 2010 and June 2016 at 55 tertiary hospitals in North America. Last follow-up was June 2017.
Two polymyxin B hemoperfusion treatments (90-120 minutes) plus standard therapy completed within 24 hours of enrollment (n = 224 patients) or sham hemoperfusion plus standard therapy (n = 226 patients).
The primary outcome was mortality at 28 days among all patients randomized (all participants) and among patients randomized with a multiple organ dysfunction score (MODS) of more than 9.
Among 450 eligible enrolled patients (mean age, 59.8 years; 177 39.3% women; mean APACHE II score 29.4 range, 0-71 with higher scores indicating greater severity), 449 (99.8%) completed the study. Polymyxin B hemoperfusion was not associated with a significant difference in mortality at 28 days among all participants (treatment group, 84 of 223 37.7% vs sham group 78 of 226 34.5%; risk difference RD, 3.2%; 95% CI, -5.7% to 12.0%; relative risk RR, 1.09; 95% CI, 0.85-1.39; P = .49) or in the population with a MODS of more than 9 (treatment group, 65 of 146 44.5% vs sham, 65 of 148 43.9%; RD, 0.6%; 95% CI, -10.8% to 11.9%; RR, 1.01; 95% CI, 0.78-1.31; P = .92). Overall, 264 serious adverse events were reported (65.1% treatment group vs 57.3% sham group). The most frequent serious adverse events were worsening of sepsis (10.8% treatment group vs 9.1% sham group) and worsening of septic shock (6.6% treatment group vs 7.7% sham group).
Among patients with septic shock and high endotoxin activity, polymyxin B hemoperfusion treatment plus conventional medical therapy compared with sham treatment plus conventional medical therapy did not reduce mortality at 28 days.
ClinicalTrials.gov Identifier: NCT01046669.
•We conducted a systematic literature review of contemporary systems thinking accident analysis methods.•Qualitative and quantitative syntheses of study results were performed for Accimap, HFACS, ...STAMP-CAST, and FRAM.•Across the methods, a majority of the contributory factors underpinning accident causation were identified at lower system levels.•The development of novel accident analysis approaches in the safety science research context is encouraged based on the findings discussed.
This systematic review examines and reports on peer reviewed studies that have applied systems thinking accident analysis methods to better understand the cause of accidents in a diverse range of sociotechnical systems contexts.
Four databases (PubMed, ScienceDirect, Scopus, Web of Science) were searched for published articles during the dates 01 January 1990 to 31 July 2018, inclusive, for original peer reviewed journal articles. Eligible studies applied AcciMap, the Human Factors Analysis and Classification System (HFACS), the Systems Theoretic Accident Model and Processes (STAMP) method, including Causal Analysis based on STAMP (CAST), and the Functional Resonance Analysis Method (FRAM). Outcomes included accidents ranging from major events to minor incidents.
A total of 73 articles were included. There were 20, 43, six, and four studies in the AcciMap, HFACS, STAMP-CAST, and FRAM methods categories, respectively. The most common accident contexts were aviation, maritime, rail, public health, and mining. A greater number of contributory factors were found at the lower end of the sociotechnical systems analysed, including the equipment/technology, human/staff, and operating processes levels. A majority of studies used supplementary approaches to enhance the analytical capacity of base applications.
Systems thinking accident analysis methods have been popular for close to two decades and have been applied in a diverse range of sociotechnical systems contexts. A number of research-based recommendations are proposed, including the need to upgrade incident reporting systems and further explore opportunities around the development of novel accident analysis approaches.
•Historical review of models and methods for collision analysis.•Analysis of the Uber collision with a pedestrian using eight methods.•Comparison of eight methods for collision analysis against ...systemic, theoretical, methodological and practical criteria.•Detailed analysis of the Uber collision with a pedestrian with Actor Map and AcciMap.•Proposed list of potential recommendations for testing automated vehicles.
Unlike aviation, maritime and rail, road traffic collision investigation currently does not have a national investigatory body in the UK. Yet the numbers of people killed and seriously injured on the roads is far in excess of those other domains. The research presented in this paper is part of a larger project investigating the development of a road collision investigation branch in the UK. An important part of the process involves identifying a suitable accident analysis method to support investigations with the development of suitable interventions. This paper describes a study that was undertaken to identify a systemic method for investigating road collisions. Eight potential methods were identified and compared using a common incident, that of the recent Uber collision with a pedestrian. The methods were analysed against four sets of criteria: systemic, theoretical, methodological and practical. The AcciMap method, together with the accompanying Actor Map, was recommended as an appropriate approach to support road traffic collision investigations.
Allergic asthma is a chronic immune-inflammatory disease of the airways. Despite aeroallergen exposure being universal, allergic asthma affects only a fraction of individuals. This is likely related, ...at least in part, to the extent of allergen exposure. Regarding house dust mite (HDM), we previously identified the threshold required to elicit allergic responses in BALB/c mice. Here, we investigated the impact of an initial immune perturbation on the response to sub-threshold HDM exposure. We show that transient GM-CSF expression in the lung facilitated robust eosinophilic inflammation, long-lasting antigen-specific Th2 responses, mucus production and airway hyperresponsiveness. This was associated with increased IL-33 levels and activated CD11b(+) DCs expressing OX40L. GM-CSF-driven allergic responses were significantly blunted in IL-33-deficient mice. IL-33 was localized on alveolar type II cells and in vitro stimulation of human epithelial cells with GM-CSF enhanced intracellular IL-33 independently of IL-1α. Likewise, GM-CSF administration in vivo resulted in increased levels of IL-33 but not IL-1α. These findings suggest that exposures to environmental agents associated with GM-CSF production, including airway infections and pollutants, may decrease the threshold of allergen responsiveness and, hence, increase the susceptibility to develop allergic asthma through a GM-CSF/IL-33/OX40L pathway.
What are normal relaxation times of tissues at 3 T? Bojorquez, Jorge Zavala; Bricq, Stéphanie; Acquitter, Clement ...
Magnetic resonance imaging,
January 2017, 2017-Jan, 2017-01-00, 20170101, Letnik:
35
Journal Article
Recenzirano
The T1 and T2 relaxation times are the basic parameters behind magnetic resonance imaging. The accurate knowledge of the T1 and T2 values of tissues allows to perform quantitative imaging and to ...develop and optimize magnetic resonance sequences. A vast extent of methods and sequences has been developed to calculate the T1 and T2 relaxation times of different tissues in diverse centers. Surprisingly, a wide range of values has been reported for similar tissues (e.g. T1 of white matter from 699 to 1735ms and T2 of fat from 41 to 371ms), and the true values that represent each specific tissue are still unclear, which have deterred their common use in clinical diagnostic imaging. This article presents a comprehensive review of the reported relaxation times in the literature in vivo at 3T for a large span of tissues. It gives a detailed analysis of the different methods and sequences used to calculate the relaxation times, and it explains the reasons of the spread of reported relaxation times values in the literature.
Optical bound states in the continuum (BICs) provide a way to engineer very narrow resonances in photonic crystals. The extended interaction time in these systems is particularly promising for the ...enhancement of nonlinear optical processes and the development of the next generation of active optical devices. However, the achievable interaction strength is limited by the purely photonic character of optical BICs. Here, we mix the optical BIC in a photonic crystal slab with excitons in the atomically thin semiconductor MoSe
to form nonlinear exciton-polaritons with a Rabi splitting of 27 meV, exhibiting large interaction-induced spectral blueshifts. The asymptotic BIC-like suppression of polariton radiation into the far field toward the BIC wavevector, in combination with effective reduction of the excitonic disorder through motional narrowing, results in small polariton linewidths below 3 meV. Together with a strongly wavevector-dependent
-factor, this provides for the enhancement and control of polariton-polariton interactions and the resulting nonlinear optical effects, paving the way toward tuneable BIC-based polaritonic devices for sensing, lasing, and nonlinear optics.
Abstract Prostate cancer is the second most diagnosed cancer of men all over the world. In the last few decades, new imaging techniques based on Magnetic Resonance Imaging (MRI) have been developed ...to improve diagnosis. In practise, diagnosis can be affected by multiple factors such as observer variability and visibility and complexity of the lesions. In this regard, computer-aided detection and computer-aided diagnosis systems have been designed to help radiologists in their clinical practice. Research on computer-aided systems specifically focused for prostate cancer is a young technology and has been part of a dynamic field of research for the last 10 years. This survey aims to provide a comprehensive review of the state-of-the-art in this lapse of time, focusing on the different stages composing the work-flow of a computer-aided system. We also provide a comparison between studies and a discussion about the potential avenues for future research. In addition, this paper presents a new public online dataset which is made available to the research community with the aim of providing a common evaluation framework to overcome some of the current limitations identified in this survey.
This paper reviews the key perspectives on human error and analyses the core theories and methods developed and applied over the last 60 years. These theories and methods have sought to improve our ...understanding of what human error is, and how and why it occurs, to facilitate the prediction of errors and use these insights to support safer work and societal systems. Yet, while this area of Ergonomics and Human Factors (EHF) has been influential and long-standing, the benefits of the 'human error approach' to understanding accidents and optimising system performance have been questioned. This state of science review analyses the construct of human error within EHF. It then discusses the key conceptual difficulties the construct faces in an era of systems EHF. Finally, a way forward is proposed to prompt further discussion within the EHF community.
Practitioner statement This state-of-science review discusses the evolution of perspectives on human error as well as trends in the theories and methods applied to understand, prevent and mitigate error. It concludes that, although a useful contribution has been made, we must move beyond a focus on an individual error to systems failure to understand and optimise whole systems.
Accident analysis methods are used to model the multifactorial cause of adverse incidents. Methods such as AcciMap, STAMP-CAST and recently AcciNet, are systemic approaches that support the ...identification of safety interventions across sociotechnical system levels. Despite their growing popularity, little is known about how reliable systems-based methods are when used to describe, model and classify contributory factors and relationships. Here, we conducted an intra-rater and inter-rater reliability assessment of AcciMap, STAMP-CAST and AcciNet using the Signal Detection Theory (SDT) paradigm. A total of 180 hours' worth of analyses across 360 comparisons were performed by 30 expert analysts. Findings revealed that all three methods produced a weak to moderate positive correlation coefficient, however the inter-rater reliability of STAMP-CAST was significantly higher compared to AcciMap and AcciNet. No statistically significant or practically meaningful differences were found between methods in the overall intra-rater reliability analyses. Implications and future research directions are discussed.
Practitioners who undertake accident analysis within their organisations should consider the use of STAMP-CAST due to the significantly higher inter-rater reliability findings obtained in this study compared to AcciMap and AcciNet, particularly if they tend to work alone and/or part of relatively small teams
Human Factors Methods and Accident Analysis is the first book to offer a practical guide for investigators, practitioners and researchers wishing to apply accident analysis methods. It is also unique ...in presenting a series of novel applications of accident analysis methods, including HF methods not previously used for these purposes (e.g. EAST, critical path analysis), as well as applications of methods in new domains.
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