Time of Admission to Intensive Care Unit, Strained Capacity, and Mortality: a Retrospective Cohort Study

Purpose: We sought to study the association between afterhours ICU admission and ICU mortality considering measures of strained ICU capacity. Materials and methods: Retrospective analysis of 4141 admissions to 2 ICUs in Lisbon, Portugal (06/2016-06/2018). Primary exposure was ICU admission on 20:00 h-07:59 h. Primary outcome was ICU mortality. Measures of strained ICU capacity were: bed occupancy rate ≥ 90% and cluster of ICU admissions 2 h before or following index admission. Results: There were 1581 (38.2%) afterhours ICU admissions. Median APACHE II score (19 vs. 20) was similar between patients admitted afterhours and others (P = .27). Patients admitted afterhours had higher crude ICU mortality (15.4% vs. 21.9%; P < .001), but similar adjusted ICU mortality (aOR [95%CI] = 1.15 [0.97-1.38]; P = .12). While bed occupancy rate ≥ 90% was more frequent in patients admitted afterhours (23.1% vs. 29.1%) or deceased in ICU (23.6% vs. 33.7%), cluster of ICU admissions was more frequent in patients admitted during daytime hours (75.2% vs. 58.9%) or that survived the ICU stay (70.1% vs. 63.9%; P ≤ .001 for all). These measures of strained ICU capacity were not associated with adjusted ICU mortality (P ≥ .10 for both). Conclusions: Afterhours ICU admission and measures of strained ICU capacity were associated with crude but not adjusted ICU mortality.info:eu-repo/semantics/publishedVersio

Primary Effusion Lymphoma in a HIV Infected Patient

O linfoma primário das cavidades é um subtipo de linfoma não-Hodgkin (LNH), de ocorrência rara, prognóstico muito reservado, mais frequentemente descrito em indivíduos imunodeprimidos, em particular no contexto de infecção pelo vírus da imunodeficiência humana (VIH), no qual as células malignas proliferam exclusivamente nas cavidades serosas e que está associado ao vírus herpes humano tipo 8 (VHH8). Os autores apresentam o caso de um doente com infecção VIH, internado por febre e queixas constitucionais e que desenvolveu, enquanto decorria estudo etiológico da síndrome febril, ascite volumosa e, ainda, derrame pleural direito e derrame pericárdico. O líquido ascítico mostrou a presença de células grandes linfóides com fenótipo não B e não T. Não foram evidenciadas massas tumorais, linfadenopatias ou envolvimento da medula óssea. O doente morreu 41 dias após o diagnóstico, sem ter iniciado quimioterapia. Ainda que não tenha sido possível a demonstração de infecção pelo VHH-8 nas células linfóides, os dados clínicos, citológicos e imunofenotípicos apontam para um diagnóstico altamente provável de linfoma primário das cavidades

The supernova-regulated ISM. II. The mean magnetic field

The origin and structure of the magnetic fields in the interstellar medium of spiral galaxies is investigated with 3D, non-ideal, compressible MHD simulations, including stratification in the galactic gravity field, differential rotation and radiative cooling. A rectangular domain, 1x1x2 kpc^{3} in size, spans both sides of the galactic mid-plane. Supernova explosions drive transonic turbulence. A seed magnetic field grows exponentially to reach a statistically steady state within 1.6 Gyr. Following Germano (1992) we use volume averaging with a Gaussian kernel to separate magnetic field into a mean field and fluctuations. Such averaging does not satisfy all Reynolds rules, yet allows a formulation of mean-field theory. The mean field thus obtained varies in both space and time. Growth rates differ for the mean-field and fluctuating field and there is clear scale separation between the two elements, whose integral scales are about 0.7 kpc and 0.3 kpc, respectively.Comment: 5 pages, 10 figures, submitted to Monthly Notices Letter

Large Eddy Simulation of Turbulent Channel Flows by the Rational LES Model

The rational large eddy simulation (RLES) model is applied to turbulent channel flows. This approximate deconvolution model is based on a rational (subdiagonal Pade') approximation of the Fourier transform of the Gaussian filter and is proposed as an alternative to the gradient (also known as the nonlinear or tensor-diffusivity) model. We used a spectral element code to perform large eddy simulations of incompressible channel flows at Reynolds numbers based on the friction velocity and the channel half-width Re{sub tau} = 180 and Re{sub tau} = 395. We compared the RLES model with the gradient model. The RLES results showed a clear improvement over those corresponding to the gradient model, comparing well with the fine direct numerical simulation. For comparison, we also present results corresponding to a classical subgrid-scale eddy-viscosity model such as the standard Smagorinsky model.Comment: 31 pages including 15 figure