Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.info:eu-repo/semantics/publishedVersio

Desire and Discipline in Primary Education

This paper, based on a three-year participant observer study in a southwestern inner city elementary school, holds that understanding the dynamic nature of the struggle between desire and discipline in an elementary school setting is crucial because those competing forces and the ensuing struggle are a majorforce in a child's secondary socialization. Our observations suggest that even very young children acquiesce to and resist authority in many ways, and in doing so learn lessons often more complicated than most of our assumptions will allow. We argue that these lessons, which are often contradictory, are born out ofthe tension between institution and inclination, between deference and autonomy, and between respectfor authority and self-respect—a tension that is not resolvable, but that can be collectively lived with in better and worse ways

Equilibrum and surface rheology of monolayers of insoluble polycations with side chains

We have studied monolayers of poly(n-tetradecyl 4-vinylpyridinium-co-4- vinylpyridine) bromide with different degrees of quaternization at the air-water interface. The isotherms (surface pressure vs area) present several phase transitions: at low monolayer coverage, there is a phase transition over a characteristic area that increases on increasing the quaternization degree. This behavior can be rationalized in terms of a mean-field theory of 2D semiflexible polymeric chains and could be an indication of a disorder-order transition from a 2D isotropic liquid (IL) at low surface concentration to a 2D nematic phase (N) at higher concentrations. Low-frequency oscillatory strain experiments show that at low surface coverage the monolayers exhibit highly nonlinear behavior, even for low strain amplitude, whereas at higher surface coverage the response is linear for strains higher than 20%. In addition, stress relaxation experiments show a minimum in the characteristic times that coincide with the transition area. These unexpected results at low surface coverage might be characteristic of the system or related to the fact that the oscillatory experiments do not strictly correspond to constant surface-coverage conditions. However, they are in agreement with high-frequency viscoelasticity, obtained by surface quasielastic light scattering, that shows that the dilational viscosity is higher at low surface concentration than for concentrations beyond the surface phase transition. At higher coverage, there is a second phase transition, after which the isotherms present hysteresis, which is not observed below. Ellipsometry indicates that, after this transition, the monolayer thicken, which may be related to 3D growth into a multilayer. © 2009 American Chemical Society.info:eu-repo/semantics/publishe