Predicting death and readmission after intensive care discharge

Background: Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge. Methods: This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU. Results: Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone. Conclusions: We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.Not peer reviewedAuthor versio

Critical discussion of Daniel C. Dennett, The Intentional Stance.

Daniel Dennett spends a good bit of time defending the possibility of a compromise position on the reality of beliefs and desires. It will be claimed that a puzzle remains in the interpretation of Dennett's position. In earlier works one finds a theme, which we can call 'near-fatalism', which has not been integrated with the kind of middle ground he describes. But the near-fatalism theme is dropped in later work. Is it because it is felt to be incompatible with that middle ground compromise? It is not obviously so

Gravitational deflection of light in Rindler-type potential as a possible resolution to the observations of Bullet Cluster 1E0657-558

The surface density $\Sigma$-map and the convergence $\kappa$-map of Bullet Cluster 1E0657-558 show that the center of baryonic matters separates from the center of gravitational force, and the distribution of gravitational force do not possess spherical symmetry. This hints that a modified gravity with difference to Newtonian inverse-square law at large scale, and less symmetry is worth investigating. In this paper, we study the dynamics in Randers-Finsler spacetime. The Newtonian limit and gravitational deflection of light in a Rindler-type potential is focused in particular. It is shown that the convergence in Finsler spacetime could account for the observations of Bullet Cluster.Comment: 11 page

Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19.

BACKGROUND: The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. METHODS: We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensive care unit (ICU), were randomly assigned to receive tocilizumab (8 mg per kilogram of body weight), sarilumab (400 mg), or standard care (control). The primary outcome was respiratory and cardiovascular organ support-free days, on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with predefined criteria for superiority, efficacy, equivalence, or futility. An odds ratio greater than 1 represented improved survival, more organ support-free days, or both. RESULTS: Both tocilizumab and sarilumab met the predefined criteria for efficacy. At that time, 353 patients had been assigned to tocilizumab, 48 to sarilumab, and 402 to control. The median number of organ support-free days was 10 (interquartile range, -1 to 16) in the tocilizumab group, 11 (interquartile range, 0 to 16) in the sarilumab group, and 0 (interquartile range, -1 to 15) in the control group. The median adjusted cumulative odds ratios were 1.64 (95% credible interval, 1.25 to 2.14) for tocilizumab and 1.76 (95% credible interval, 1.17 to 2.91) for sarilumab as compared with control, yielding posterior probabilities of superiority to control of more than 99.9% and of 99.5%, respectively. An analysis of 90-day survival showed improved survival in the pooled interleukin-6 receptor antagonist groups, yielding a hazard ratio for the comparison with the control group of 1.61 (95% credible interval, 1.25 to 2.08) and a posterior probability of superiority of more than 99.9%. All secondary analyses supported efficacy of these interleukin-6 receptor antagonists. CONCLUSIONS: In critically ill patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists tocilizumab and sarilumab improved outcomes, including survival. (REMAP-CAP ClinicalTrials.gov number, NCT02735707.)

Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study

A41 Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study In: Addiction Science & Clinical Practice 2017, 12(Suppl 1): A4

Analysis of fracture induced scattering of microseismic shear-waves

Fractures are pervasive features within the Earth’s crust and have a significant influence on the multi-physical response of the subsurface. The presence of coherent fracture sets often leads to observable seismic scattering enabling seismic techniques to remotely locate and characterise fracture systems. In this study, we confirm the general scale-dependence of seismic scattering and provide new results specific to shear-wave propagation. We do this by generating full waveform synthetics using finite-difference wave simulation within an isotropic background model containing explicit fractures. By considering a suite of fracture models having variable fracture density and fracture size, we examine the widening effect of wavelets due to scattering within a fractured medium by using several different approaches, such as root-mean-square envelope analysis, shear-wave polarisation distortion, differential attenuation analysis and peak frequency shifting. The analysis allows us to assess the scattering behavior of parametrised models in which the propagation direction is either normal or parallel to the fracture surfaces. The quantitative measures show strong observable deviations for fractures size on the order of or greater than the dominant seismic wavelength within the Mie and geometric scattering regime for both propagation normal and parallel to fracture strike. The results suggest that strong scattering is symptomatic of fractures having size on the same order of the probing seismic wave