Corticosteroids influence the mortality and morbidity of acute critical illness

INTRODUCTION: Use of corticosteroids for adrenal supplementation and attenuation of the inflammatory and immune response is widespread in acute critical illness. The study hypothesis was that exposure to corticosteroids influences the mortality and morbidity in acute critical illness. METHODS: This case–control retrospective study was performed in a single multidisciplinary intensive care unit at a tertiary care institution and consisted of 10,285 critically ill patients admitted between 1 January 1999 and 31 December 2004. Demographics, comorbidities, acute illness characteristics including severity measured by Sequential Organ Failure Assessment, concurrent medications, therapeutic interventions and incidence of infections were obtained from electronic medical records, were examined with multiple regression analysis and were adjusted for propensity of corticosteroid exposure. The primary outcome was hospital death, and the secondary outcome was transfer to a care facility at hospital discharge. RESULTS: Corticosteroid exposure in 2,632 (26%) patients was characterized by younger age, more females, higher Charlson comorbidity and maximal daily Sequential Organ Failure Assessment scores compared with control patients. Corticosteroids potentiated metabolic and neuromuscular sequels of critical illness with increased requirements for diuretics, insulin, protracted weaning from mechanical ventilation, need for tracheostomy and discharge to a care facility. Early exposure to corticosteroids predisposed to recurrent and late onset of polymicrobial and fungal hospital-acquired infections. Corticosteroids increased the risk for death or disability after adjustments for comorbidities and acute illness characteristics. CONCLUSION: Corticosteroids increased the risk for death or disability in critical illness. Hospital-acquired infections and metabolic and neuromuscular sequels of critical illness were exacerbated by corticosteroids. Careful appraisal of the indications for use of corticosteroids is necessary to balance the benefits and risks from exposure in acute critical illness

Inequities in treatments and outcomes among patients hospitalized with hypertrophic cardiomyopathy in the United States

Background Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies, sociodemographic factors have been associated with disparities in septal reduction therapy, but little is known about the association of sociodemographic factors with HCM treatments and outcomes more broadly. Methods and Results Using the National Inpatient Survey from 2012 to 2018, HCM diagnoses and procedures were identified b

Puente-paso para una estación de autobuses, California, (EE.UU.)

The bus terminal has been built in three independent platforms, connected to one another by a 40 m-span bridge and to the two directions of traffic of the expressway below, by means of two stairs-and-lifts towers located at both ends of the access lobby, so as to facilitate pedestrian traffic to the two levels of the said expressway in the neighbourhood of the university campus. It deserves pointing out in this design, as a whole, the harmonious integration of the structural requirements — in reinforced concrete and metal window framing — with the aesthetic and functional criteria, something not commonly found in this type of buildings, more often considered as secondary and with little architectural value. This design has deserved the Honor Award of the South California Chapter of the American institute of Architects.Para posibilitar el acceso peatonal a los dos distintos niveles de la autopista inmediata al campus universitario, la estación de autobuses se ha realizado con tres plataformas independientes, unidas entre sí mediante un puente de 40 m de luz, y enlazadas verticalmente, con los dos sentidos de circulación de la autopista, a través de dos torres con escaleras y ascensores situados en los extremos del vestíbulo de acceso. En el conjunto destaca la armónica integración de las necesidades estructurales, resueltas a base de hormigón armado y carpintería metálica, y los valores estéticos y funcionales, pocas veces lograda en obras de esta naturaleza, normalmente consideradas como secundarias o de poco valor arquitectónico. El proyecto ha merecido el premio de honor del Instituto Americano de arquitectos de California del Sur

How Spatially Resolved Polarimetry Informs Black Hole Accretion Flow Models

The Event Horizon Telescope (EHT) Collaboration has successfully produced images of two supermassive black holes, enabling novel tests of black holes and their accretion flows on horizon scales. The EHT has so far published total intensity and linear polarization images, while upcoming images may include circular polarization, rotation measure, and spectral index, each of which reveals different aspects of the plasma and space-time. The next-generation EHT (ngEHT) will greatly enhance these studies through wider recorded bandwidths and additional stations, leading to greater signal-to-noise, orders of magnitude improvement in dynamic range, multi-frequency observations, and horizon-scale movies. In this paper, we review how each of these different observables informs us about the underlying properties of the plasma and the spacetime, and we discuss why polarimetric studies are well-suited to measurements with sparse, long-baseline coverage.Comment: Submitted for Galaxies Special Issue "From Vision to Instrument: Creating a Next-Generation Event Horizon Telescope for a New Era of Black Hole Science

Effects of transition metal substitutions on the incommensurability and spin fluctuations in BaFe2As2 by elastic and inelastic neutron scattering

The spin fluctuation spectra from nonsuperconducting Cu-substituted, and superconducting Co-substituted, BaFe2As2 are compared quantitatively by inelastic neutron scattering measurements and are found to be indis- tinguishable. Whereas diffraction studies show the appearance of incommensurate spin-density wave order in Co and Ni substituted samples, the magnetic phase diagram for Cu substitution does not display incommensu- rate order, demonstrating that simple electron counting based on rigid-band concepts is invalid. These results, supported by theoretical calculations, suggest that substitutional impurity effects in the Fe plane play a signifi- cant role in controlling magnetism and the appearance of superconductivity, with Cu distinguished by enhanced impurity scattering and split-band behavior.Comment: 5 pages, 5 figures, Major change in the manuscrip

Centro médico St.Vincent Los Ángeles – (EE.UU.)

The building for the new St. Vicent Hospital, considered among the most important medical centers in Los Angeles, particularly for cardio-vascular medicine, has five patient- room storeys and three lower floors housing the medical specialities of the Centre. The arrangement of the typical floors around a central core, containing lifts, staircases and common services, permits a convenient and functional organization of the space. The total built-up area is 32,800 m2 with a hospital capacity of 385 beds, 314 of which area destined to patients in serious condition and 71 for surgery. The aim of the architects was to design a highly efficient building from the standpoint of medical functionality, while at the same time, avoiding the cold institutional feeling, providing instead a warm and humane atmosphere both from the outside and in the interiors.El edificio del nuevo hospital de St. Vincent, considerado como uno de los centros médicos más completos de Los Ángeles, particularmente en lo que se refiere a medicina cardiovascular, consta de cinco plantas superiores destinadas a habitaciones de pacientes, y tres inferiores que albergan las especialidades médicas del centro. La disposición de las plantas en torno a un núcleo central de escaleras, ascensores y servicios, permite una cómoda organización de funcionamiento. La edificabilidad total empleada es de 32.800 m2, siendo la capacidad hospitalaria de 385 camas, de las que 314 se destinan a pacientes graves y 71 a cirugía. El propósito de los arquitectos fue el de diseñar un edificio con un grado óptimo de funcionamiento médico, que evitara características frías e institucionales y proporcionara en cambio, tanto hacia fuera como en el interior, ambientes cálidos y humanos

Scallop swimming kinematics and muscle performance: modelling the effects of "within-animal" variation in temperature sensitivity

Escape behaviour was investigated in Queen scallops (Aequipecten opercularis) acclimated to 5, 10 or 15 degrees C and tested at their acclimation temperature. Scallops are active molluscs, able to escape from predators by jet-propelled swimming using a striated muscle working in opposition to an elastic hinge ligament. The first cycle of the escape response was recorded using high-speed video ( 250 Hz) and whole-animal velocity and acceleration determined. Muscle shortening velocity, force and power output were calculated using measurements of valve movement and jet area, and a simple biomechanical model. The average shortening speed of the adductor muscle had a Q(10) of 2.04, significantly reducing the duration of the jetting phase of the cycle with increased temperature. Muscle lengthening velocity and the overall duration of the clap cycle were changed little over the range 5 - 15 degrees C, as these parameters were controlled by the relatively temperature-insensitive, hinge ligament. Improvements in the average power output of the adductor muscle over the first clap cycle ( 222 vs. 139 W kg(-1) wet mass at 15 and 5 degrees C respectively) were not translated into proportional increases in overall swimming velocity, which was only 32% higher at 15 degrees C ( 0.37m s(-1)) than 5 degrees C (0.28 m s(-1))

Predicting intraurban airborne PM1.0-trace elements in a port city : Land use regression by ordinary least squares and a machine learning algorithm

Airborne particulate matter (PM) has been associated with cardiovascular and respiratory morbidity and mortality, and there is some evidence that spatially varying metals found in PM may contribute to adverse health effects. We developed spatially refined models for PM trace elements using ordinary least squares land use regression (OLS-LUR) and machine leaning random forest land-use regression (RF-LUR). Two-week integrated measurements of PM1.0 (median aerodiameter < 1.0 μm) were collected at 50 sampling sites during fall (2010), winter (2011), and summer (2011) in the Halifax Regional Municipality, Nova Scotia, Canada. PM1.0 filters were analyzed for metals and trace elements using inductively coupled plasma-mass spectrometry. OLS- and RF-LUR models were developed for approximately 30 PM1.0 trace elements in each season. Model predictors included industrial, commercial, and institutional/ government/ military land use, roadways, shipping, other transportation sources, and wind rose information. RF generated more accurate models than OLS for most trace elements based on 5-fold cross validation. On average, summer models had the highest cross validation R2 (OLS-LUR = 0.40, RF-LUR = 0.46), while fall had the lowest (OLS-LUR = 0.27, RF-LUR = 0.31). Many OLS-LUR models displayed overprediction in the final exposure surface. In contrast, RF-LUR models did not exhibit overpredictions. Taking overpredictions and cross validation performances into account, OLS-LUR performed better than RF-LUR in roughly 20% of the seasonal trace element models. RF-LUR models provided more interpretable predictors in most cases. Seasonal predictors varied, likely due to differences in seasonal distribution of trace elements related to source activity, and meteorology

Single-walled carbon nanotubes as excitonic optical wires

Although metallic nanostructures are useful for nanoscale optics, all of their key optical properties are determined by their geometry. This makes it difficult to adjust these properties independently, and can restrict applications. Here we use the absolute intensity of Rayleigh scattering to show that single-walled carbon nanotubes can form ideal optical wires. The spatial distribution of the radiation scattered by the nanotubes is determined by their shape, but the intensity and spectrum of the scattered radiation are determined by exciton dynamics, quantum-dot-like optical resonances and other intrinsic properties. Moreover, the nanotubes display a uniform peak optical conductivity of ~8 e^2/h, which we derive using an exciton model, suggesting universal behaviour similar to that observed in nanotube conductance. We further demonstrate a radiative coupling between two distant nanotubes, with potential applications in metamaterials and optical antennas