National variation in United States sepsis mortality: a descriptive study

<p>Abstract</p> <p>Background</p> <p>The regional distribution of a disease may provide important insights regarding its pathophysiology, risk factors and clinical care. While sepsis is a prominent cause of death in the United States (US), few studies have examined regional variations with this malady. We identified the national variation in sepsis deaths in the US. We conducted a descriptive analysis of 1999-2005 national vital statistics data from the National Center for Health Statistics summarized at the state-level. We defined sepsis deaths as deaths attributed to an infection, classified according to the International Classification of Diseases, Version 10. We calculated national and state age-adjusted sepsis-attributed mortality rates.</p> <p>Results</p> <p>National age-adjusted sepsis mortality was 65.5 per 100,000 persons (95% CI: 65.8 - 66.0). State level sepsis mortality varied more than two-fold (range 41 to 88.6 per 100,000 persons; median 60.8 per 100,000, IQR 53.9-74.4 per 100,000). A cluster extending from the Southeastern to the mid-Atlantic US encompassed states with the highest sepsis mortality.</p> <p>Conclusions</p> <p>Sepsis mortality varies across the US. The states with highest sepsis mortality form a contiguous cluster in the Southeastern and mid-Atlantic US. These observations highlight unanswered questions regarding the characteristics and care of sepsis.</p

The Old Bailey proceedings and the representation of crime and criminal justice in eighteenth-century London

The Proceedings of the Old Bailey, published accounts of felony trials held at London’s central criminal court, were a remarkable publishing phenomenon. First published in 1674, they quickly became a regular periodical, with editions published eight times a year following each session of the court. Despite the huge number of trial reports (some 50,000 in the eighteenth century), the Proceedings, also known as the “Sessions Papers”, have formed the basis of several important studies in social history, dating back to Dorothy George’s seminal London Life in the Eighteenth Century (1925). Their recent publication online, however, has not only made them more widely available, but also changed the way historians consult them, leading to greater use of both quantitative analysis, using the statistics function, and qualitative examination of their language, through keyword searching. In the context of recent renewed interest in the history of crime and criminal justice, for which this is the most important source available in this period, the growing use of the Proceedings raises questions about their reliability, and, by extension, the motivations for their original publication. Historians generally consider the Proceedings to present accurate, if often incomplete, accounts of courtroom proceedings. From this source, along with manuscript judicial records, criminal biographies (including the Ordinary’s Accounts), polemical pamphlets such as Henry Fielding’s Enquiry into the Causes of the Late Increase of Robbers (1751), and of course the satirical prints of William Hogarth, they have constructed a picture of eighteenth-century London as a city overwhelmed by periodic crime waves and of a policing and judicial system which was forced into wide-ranging reforms in order to meet this challenge

Turning points in multilateral trade negotiations on intellectual property

Detailed chronologies of events that transpired during the discussion of intellectual property issues (TRIPS) in the GATT Uruguay Round and prior to and during the WTO Doha Ministerial are used to trace the unfolding negotiation processes through time. Of particular interest are departures from earlier trends in the chronologies. A departure is defined as a clear and self evident change from earlier events or patterns in the form of an impactful decision taken by one or more parties. By coding the causes (precipitants) and effects (consequences) of the departures, we perform a turning points analysis. These three-part sequences reveal the triggers and impacts of departures during the extended TRIPS negotiation process. The analyses will allow a comparison of the patterns that unfolded during the two phases of TRIPS negotiations. This comparison will highlight the breakthroughs that occurred during the Uruguay Round and the crises that emerged later, prior to and during the Doha Ministerial. It will also have implications more generally for the way that comparative analyses of international negotiation are performed

Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

IntroductionPerioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce the risk of postoperative acute kidney injury (AKI).Methods and analysisAfter receipt of grant funding, serial postoperative serum creatinine measurements began to be recorded in consecutive patients enrolled at substudy participating centres. With respect to the study schedule, the last of over 6500 substudy patients from 82 centres in 21 countries were randomised in December 2013. The authors will use logistic regression to estimate the adjusted OR of AKI following surgery (compared with the preoperative serum creatinine value, a postoperative increase ≥26.5 μmol/L in the 2 days following surgery or an increase of ≥50% in the 7 days following surgery) comparing each intervention to placebo, and will report the adjusted relative risk reduction. Alternate definitions of AKI will also be considered, as will the outcome of AKI in subgroups defined by the presence of preoperative chronic kidney disease and preoperative chronic aspirin use. At the time of randomisation, a subpopulation agreed to a single measurement of serum creatinine between 3 and 12 months after surgery, and the authors will examine intervention effects on this outcome.Ethics and disseminationThe authors were competitively awarded a grant from the Canadian Institutes of Health Research for this POISE-2 AKI substudy. Ethics approval was obtained for additional kidney data collection in consecutive patients enrolled at participating centres, which first began for patients enrolled after January 2011. In patients who provided consent, the remaining longer term serum creatinine data will be collected throughout 2014. The results of this study will be reported no later than 2015.Clinical Trial Registration NumberNCT01082874

Perioperative events influence cancer recurrence risk after surgery.

Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article