Identifying which septic patients have increased mortality risk using severity scores:a cohort study

Background: Early aggressive therapy can reduce the mortality associated with severe sepsis but this relies on prompt recognition, which is hindered by variation among published severity criteria. Our aim was to test the performance of different severity scores in predicting mortality among a cohort of hospital inpatients with sepsis. Methods: We anonymously linked routine outcome data to a cohort of prospectively identified adult hospital inpatients with sepsis, and used logistic regression to identify associations between mortality and demographic variables, clinical factors including blood culture results, and six sets of severity criteria. We calculated performance characteristics, including area under receiver operating characteristic curves (AUROC), of each set of severity criteria in predicting mortality. Results: Overall mortality was 19.4% (124/640) at 30 days after sepsis onset. In adjusted analysis, older age (odds ratio 5.79 (95% CI 2.87-11.70) for ≥80y versus <60y), having been admitted as an emergency (OR 3.91 (1.31-11.70) versus electively), and longer inpatient stay prior to sepsis onset (OR 2.90 (1.41-5.94) for >21d versus <4d), were associated with increased 30 day mortality. Being in a surgical or orthopaedic, versus medical, ward was associated with lower mortality (OR 0.47 (0.27-0.81) and 0.26 (0.11-0.63), respectively). Blood culture results (positive vs. negative) were not significantly association with mortality. All severity scores predicted mortality but performance varied. The CURB65 community-acquired pneumonia severity score had the best performance characteristics (sensitivity 81%, specificity 52%, positive predictive value 29%, negative predictive value 92%, for 30 day mortality), including having the largest AUROC curve (0.72, 95% CI 0.67-0.77). Conclusions: The CURB65 pneumonia severity score outperformed five other severity scores in predicting risk of death among a cohort of hospital inpatients with sepsis. The utility of the CURB65 score for risk-stratifying patients with sepsis in clinical practice will depend on replicating these findings in a validation cohort including patients with sepsis on admission to hospital

Chain Galaxies are Edge-On Low Surface Brightness Galaxies

Deep HST WFPC2 images have revealed a population of very narrow blue galaxies which Cowie et al. (1996) have interpreted as being a new morphological class of intrinsically linear star forming galaxies at $z=0.5-3$. We show that the same population exists in large numbers at low redshifts (z=0.03) and are actually the edge-on manifestation of low surface brightness disk galaxies.Comment: 18 pages + 3 pages of figures. Uuencoded, gzipped, tar file of 1 latex file, 5 figures, and 2 latex style files. To appear in the Astrophysical Journal Letter

Recursion operator for stationary Nizhnik--Veselov--Novikov equation

We present a new general construction of recursion operator from zero curvature representation. Using it, we find a recursion operator for the stationary Nizhnik--Veselov--Novikov equation and present a few low order symmetries generated with the help of this operator.Comment: 6 pages, LaTeX 2

Towards a publicly available, map-based regional software tool to estimate unregulated daily streamflow at ungauged rivers

Streamflow information is critical for addressing any number of hydrologic problems. Often, streamflow information is needed at locations that are ungauged and, therefore, have no observations on which to base water management decisions. Furthermore, there has been increasing need for daily streamflow time series to manage rivers for both human and ecological functions. To facilitate negotiation between human and ecological demands for water, this paper presents the first publicly available, map-based, regional software tool to estimate historical, unregulated, daily streamflow time series (streamflow not affected by human alteration such as dams or water withdrawals) at any user-selected ungauged river location. The map interface allows users to locate and click on a river location, which then links to a spreadsheet-based program that computes estimates of daily streamflow for the river location selected. For a demonstration region in the northeast United States, daily streamflow was, in general, shown to be reliably estimated by the software tool. Estimating the highest and lowest streamflows that occurred in the demonstration region over the period from 1960 through 2004 also was accomplished but with more difficulty and limitations. The software tool provides a general framework that can be applied to other regions for which daily streamflow estimates are needed

On the investigations of galaxy redshift periodicity

In this article we present a historical review of study of the redshift periodicity of galaxies, starting from the first works performed in the seventies of the twentieth century until the present day. We discuss the observational data and methods used, showing in which cases the discretization of redshifts was observed. We conclude that galaxy redshift periodisation is an effect which can really exist. We also discussed the redshift discretization in two different structures: the Local Group of galaxies and the Hercules Supercluster. Contrary to the previous studies we consider all galaxies which can be regarded as a structure member disregarding the accuracy of velocity measurements. We applied the power spectrum analysis using the Hann function for weighting, together with the jackknife error estimator. In both the structures we found weak effects of redshift periodisation.Comment: 10 pages, 4 figures, to be published in Part. and Nucl. Lett. 200

[Editorial] Accounting scholarship and management by numbers

There is a plethora of indices ranking universities, departments, and individual researchers based on a variety of indices. These invariably include a measurement of research, usually based on a combination of quantity and quality of journal publications. Informal discussions with accounting researchers invariably turns to the question of journal rankings and performance management indicators. Why is this so

Post-operative bilateral adrenal haemorrhage: A case report

AbstractINTRODUCTIONBilateral adrenal haemorrhage is a rare, but serious, illness carrying an estimated 15% mortality.1,2 The majority of cases occur in patients with acute, stressful illness, however the exact mechanism underlying adrenal haemorrhage remains unclear. This medical emergency carries significant diagnostic difficulty4 with non-specific clinical symptoms and variations in electrolyte abnormalities. Timely treatment is important as it prevents both the acute and long-term sequelae of adrenal failure.PRESENTATION OF CASEThis report describes a medical emergency in a surgical patient following emergency surgery for intra-abdominal sepsis. The patient reported non-specific symptoms of confusion, mild pyrexia and vague abdominal pain during the post-operative phase, with subtle electrolyte abnormalities and a low serum cortisol suggestive of adrenal crisis. Timely medical treatment, with intravenous hydrocortisone and intensive monitoring, and appropriate medical follow-up with addition of long-term fludrocortisone resulted in a satisfactory outcome.DISCUSSIONThis report describes a potentially life-threatening complication of intra-abdominal sepsis with adrenal crisis secondary to bilateral adrenal haemorrhage. In particular, this case highlights the diagnostic difficulty in such surgical patients due to vague symptoms and, in this case, the presence of a presentation variant with acute hyponatraemia and normal potassium.CONCLUSIONThis case highlights the importance of awareness of both the symptoms and signs and variation in electrolyte profile when assessing surgical patients post-operatively. In addition, this case highlights the benefit of early recognition and initiation of treatment and the importance of follow-up as long-term medical management is often required to prevent further relapse