The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Purpose: This study aimed to establish which prognostic scoring tool provides the greatest discriminative ability when assessing critically ill cirrhotic patients in a general intensive care unit (ICU) setting.<p></p> Methods: This was a 12-month, single-centered prospective cohort study performed in a general, nontransplant ICU. Forty clinical and demographic variables were collected on admission to calculate 8 prospective scoring tools. Patients were followed up to obtain ICU and inhospital mortality. Receiver operating characteristic curve analysis was used to determine the discriminative ability of the scores. Univariate and multivariate analyses were used to identify any independent predictors of mortality in these patients. The incorporation of any significant variables into the scoring tools was assessed.<p></p> Results: Fifty-nine cirrhotic patients were admitted over the study period, with an ICU mortality of 31%. All scores other than the renal-specific Acute Kidney Injury Network score had similar discriminative abilities, producing area under the curves of between 0.70 and 0.76. None reached the clinically applicable level of 0.8. The Sequential Organ Failure Assessment score was the best performing score. Lactate and ascites were individual predictors of ICU mortality with statistically significant odds ratios of 1.69 and 5.91, respectively. When lactate was incorporated into the Child-Pugh score, its prognostic accuracy increased to a clinically applicable level (area under the curve, 0.86).<p></p> Conclusions: This investigation suggests that established prognostic scoring systems should be used with caution when applied to the general, nontransplant ICU as compared to specialist centers. Our data suggest that serum arterial lactate may improve the prognostic ability of these scores

Georeferencing the MacConnell Aerial Photo Collection

In the 1950s, Professor William P. MacConnell from the University of Massachusetts Forestry Department began working with his students to map the land cover in Massachusetts via the state’s earliest aerial photography program. These individual photographs are now part of the Special Collections and University Archives at the University of Massachusetts Amherst Libraries, and although they have been digitized and made available online, they have not yet been georeferenced. In Spring 2021, our team (Alex and Matthew) began manually georeferencing the photos in ArcMap 10.8 software onto USGS 2019 color orthoimagery of Massachusetts available from MassGIS. Ideal ground control points include building corners, intersections, and any other distinctive features that have not resulted in much change between the historic and contemporary aerial photos. Some challenges we have faced include varying angles in which the photos were taken, cliffs that offset height in parts of the photo, or photos with a heavily forested area that makes georeferencing difficult to pinpoint ground control points. The goal of the project is to georeference the approximately 4,800 individual photos from the 1951-52 series, which spans the entire state of Massachusetts, in order to make them available to the general public as downloadable GeoTIFFs. This result will allow anyone to access the photos and use them to analyze land-use changes in Massachusetts spanning the last 70 years. Manual georeferencing has come with its own challenges when encountering heavily forested aerial photos or aerial photos dominated by mostly urban areas. We find that future research into the potential automation of the georeferencing process would help alleviate the challenges associated with manual georeferencing

Teaching what Society Needs:“Hacking” an Introductory Marketing Course with Sustainability and Macromarketing

Marketing classes are often focused on the micro level, failing to account for wider societal issues. In this article, we argue for the inclusion of a wider macro-sustainability focus, one that "hacks" marketing education. With that objective in mind, we developed and delivered an introductory marketing course that integrated both the micro and the macro, thus infusing the course with macro-sustainability. This was done through an "expanded voice" perspective that included alternate complementary micro and macro class sessions while using a traditional managerial marketing textbook supplemented by macro-sustainability materials. We also integrated a controversies approach to support discussion and learning. We taught this course to 150 undergraduate students and conducted both quantitative and qualitative assessments of the course, including comparing results with an "unhacked" marketing course. Findings indicated increased awareness of macro-sustainability topics and movement on appreciation of sustainability and the role marketing can have in achieving this awareness. Finally, we offer a model of how marketing classes at all levels can be "hacked" with a macro-sustainability approach

Do alcohol use disorders impact on long term outcomes from intensive care?

Introduction: There is limited evidence regarding the impact of alcohol use disorders on long term outcomes from intensive care. The aims of this study were to analyse the nature and complications of alcohol related admissions to intensive care and determine whether alcohol use disorders impact on survival at six months post ICU discharge.<p></p> Method: This was an 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk, harmful/hazardous, or alcohol dependency.<p></p> Results: 34.4% of patients were admitted with an alcohol use disorder. Those with an alcohol related admission (either harmful/hazardous or alcohol dependent) had an increased odds of developing septic shock during their admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p = 0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p = 0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p = 0.004). After adjustment for deprivation category and age, alcohol dependence was associated with an almost two fold increased odds of mortality at six months post ICU discharge (HR 1.86; CI 1.30-2.70, p = 0.001).<p></p> Conclusion: Alcohol use disorders are a significant risk factor for the development of septic shock in intensive care. Further, alcohol dependency is independently associated with poorer long term outcomes from intensive care.<p></p&gt

Active‐matrix organic light‐emitting displays employing two thin‐film‐transistor a‐Si:H pixels on flexible stainless‐steel foil

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92136/1/1.2759547.pd

KSU Chamber Singers and Men\u27s Ensemble

KSU School of Music presents Chamber Singers and Men\u27s Ensemble.https://digitalcommons.kennesaw.edu/musicprograms/1157/thumbnail.jp

Slate Literary Magazine, 2012-2013

Trinity College\u27s Literary Magazine - student works.https://digitalrepository.trincoll.edu/slate/1000/thumbnail.jp

Trends and level of control of hypertension among adults attending an ambulatory HIV clinic in Kampala, Uganda: a retrospective study.

BACKGROUND: With an ageing HIV-positive population, sub-Saharan Africa is now facing a dual epidemic of communicable and non-communicable diseases (NCDs). This study aimed to assess trends in the prevalence of hypertension and factors associated with hypertension, among adults attending an ambulatory HIV clinic in Kampala, Uganda. METHODS: We conducted a retrospective chart review to identify patients with hypertension. We used a random number generator to select 400 patient charts from each year from 2009 to 2014. Blood pressure, age, body mass index (BMI), WHO disease stage and Karnofsky scores were extracted. Logistic regression was used to estimate the strength of the association between each of these factors and the presence of hypertension. RESULTS: In total, 1996 charts were included in this analysis. The mean age of participants was 31 years and 1311/1996 (65.7%) were female. The overall prevalence of hypertension was 418/1996 (20.9%). This rose from 16.9% in 2009 to 32.3% in 2013. Of the patients with hypertension, 96/418 (23.0%) were receiving adequate treatment. Patients >50 years of age had 3.12 times the odds of hypertension compared with patients aged 20-29 years (95% CI 2.00 to 4.85). Men had 1.65 times the odds of hypertension compared with women (95% CI 1.34 to 2.03) and patients with a BMI of 35-39 kg/m2 had 3.93 times the odds of hypertension compared with patients with a BMI <25 kg/m2. CONCLUSIONS: The prevalence of hypertension is rising in the Ugandan HIV-positive population. There remains inadequate management and control of hypertension in this group highlighting the need to better integrate NCD care within the HIV clinical settings

The stable hydrogen isotopic composition of sedimentary plant waxes as quantitative proxy for rainfall in the West African Sahel

Various studies have demonstrated that the stable hydrogen isotopic composition (δD) of terrestrial leaf waxes tracks that of precipitation (δD_(precip)) both spatially across climate gradients and over a range of different timescales. Yet, reconstructed estimates of δD_(precip) and corresponding rainfall typically remain largely qualitative, due mainly to uncertainties in plant ecosystem net fractionation, relative humidity, and the stability of the amount effect through time. Here we present δD values of the C_(31) n-alkane (δD_(wax)) from a marine sediment core offshore the Northwest (NW) African Sahel covering the past 100 years and overlapping with the instrumental record of rainfall. We use this record to investigate whether accurate, quantitative estimates of past rainfall can be derived from our δD_(wax) time series. We infer the composition of vegetation (C_3/C_4) within the continental catchment area by analysis of the stable carbon isotopic composition of the same compounds (δ^(13)C_(wax)), calculated a net ecosystem fractionation factor, and corrected the δD_(wax) time series accordingly to derive δD_(precip). Using the present-day relationship between δD_(precip) and the amount of precipitation in the tropics, we derive quantitative estimates of past precipitation amounts. Our data show that (a) vegetation composition can be inferred from δ^(13)C_(wax), (b) the calculated net ecosystem fractionation represents a reasonable estimate, and (c) estimated total amounts of rainfall based on δD_(wax) correspond to instrumental records of rainfall. Our study has important implications for future studies aiming to reconstruct rainfall based on δD_(wax); the combined data presented here demonstrate that it is feasible to infer absolute rainfall amounts from sedimentary δD_(wax) in tandem with δ^(13)C_(wax) in specific depositional settings