8 research outputs found

    Climate Change: An Alaskan Perspective

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    Citing ‚Äúalmost universal acceptance that our planet is warming,‚ÄĚ Sen. Lisa Murkowski (R-Alaska) told an audience at Catholic University‚Äôs law school that the smartest path to controlling climate change lies in a combination of new technologies to reduce greenhouse gases, helping developing countries adopt new and cleaner energy sources and bringing economic development to countries facing extreme poverty. A member of the Senate Energy and Natural Resources Committee, Murkowski‚Äôs Brendan Brown Lecture represented the senator‚Äôs most detailed statement so far on the issue of planetary warming. ‚ÄúClimate change is real and something we‚Äôll be dealing with throughout our lifetimes,‚ÄĚ she said

    ERA Joint Resolution on Timeline for Ratification

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    Removing the deadline for the ratification of the equal rights amendment

    ERA Joint Resolution on Timeline for Ratification

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    Removing the deadline for the ratification of the equal rights amendment

    Cytokine Profiles of Severe Influenza Virus-Related Complications in Children

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    RationaleEffective immunomodulatory therapies for children with life-threatening ‚Äúcytokine storm‚ÄĚ triggered by acute influenza infection are lacking. Understanding the immune profiles of children progressing to severe lung injury and/or septic shock could provide insight into pathogenesis.ObjectivesTo compare the endotracheal and serum cytokine profiles of children with influenza-related critical illness and to identify their associations with severe influenza-associated complications.MethodsChildren with influenza-related critical illness were enrolled across 32 hospitals in development (N‚ÄČ=‚ÄČ171) and validation (N‚ÄČ=‚ÄČ73) cohorts (December 2008 through May 2016). Concentrations of 42 cytokines were measured in serum and endotracheal samples and clustered into modules of covarying cytokines. Relative concentrations of cytokines and cytokine modules were tested for associations with acute lung injury (ALI), shock requiring vasopressors, and death/ECMO.Measurements and main resultsModules of covarying cytokines were more significantly associated with disease severity than individual cytokines. In the development cohort, increased levels of a serum module containing IL6, IL8, IL10, IP10, GCSF, MCP1, and MIP1őĪ [shock odds ratio (OR)‚ÄČ=‚ÄČ3.37, family-wise error rate (FWER) p‚ÄČ<‚ÄČ10‚ąí4], and decreased levels of a module containing EGF, FGF2, SCD40L, and PAI-1 (shock OR‚ÄČ=‚ÄČ0.43, FWER p‚ÄČ=‚ÄČ0.002), were both associated with ALI, shock, and death-ECMO independent of age and bacterial coinfection. Both of these associations were confirmed in the validation cohort. Endotracheal and serum cytokine associations differed markedly and were differentially associated with clinical outcomes.ConclusionWe identified strong positive and negative associations of cytokine modules with the most severe influenza-related complications in children, providing new insights into the pathogenesis of influenza-related critical illness in children. Effective therapies may need to target mediators of both inflammation and repair

    Performance of the PEdiatric Logistic Organ Dysfunction-2 score in critically ill children requiring plasma transfusions

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    BackgroundOrgan dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the performance of the PELOD-2 score in a subpopulation of critically ill children requiring plasma transfusions.MethodsThis was an ancillary study of a prospective observational study on plasma transfusions over a 6-week period, in 101 PICUs in 21 countries. All critically ill children who received at least one plasma transfusion during the observation period were included. PELOD-2 scores were measured on days 1, 2, 5, 8, and 12 after plasma transfusion. Performance of the score was assessed by the determination of the discrimination (area under the ROC curve: AUC) and the calibration (Hosmer‚ÄďLemeshow test).ResultsFour hundred and forty-three patients were enrolled in the study (median age and weight: 1¬†year and 9.1¬†kg, respectively). Observed mortality rate was 26.9¬†% (119/443). For PELOD-2 on day 1, the AUC was 0.76 (95¬†% CI 0.71‚Äď0.81) and the Hosmer‚ÄďLemeshow test was p¬†=¬†0.76. The serial evaluation of the changes in the daily PELOD-2 scores from day 1 demonstrated a significant association with death, adjusted for the PELOD-2 score on day 1.ConclusionsIn a subpopulation of critically ill children requiring plasma transfusion, the PELOD-2 score has a lower but acceptable discrimination than in an entire population. This score should therefore be used cautiously in this specific subpopulation.</p
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