Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals

Importance: Sepsis is present in many hospitalizations that culminate in death. The contribution of sepsis to these deaths, and the extent to which they are preventable, is unknown. Objective: To estimate the prevalence, underlying causes, and preventability of sepsis-associated mortality in acute care hospitals. Design, Setting, and Participants: Cohort study in which a retrospective medical record review was conducted of 568 randomly selected adults admitted to 6 US academic and community hospitals from January 1, 2014, to December 31, 2015, who died in the hospital or were discharged to hospice and not readmitted. Medical records were reviewed from January 1, 2017, to March 31, 2018. Main Outcomes and Measures: Clinicians reviewed cases for sepsis during hospitalization using Sepsis-3 criteria, hospice-qualifying criteria on admission, immediate and underlying causes of death, and suboptimal sepsis-related care such as inappropriate or delayed antibiotics, inadequate source control, or other medical errors. The preventability of each sepsis-associated death was rated on a 6-point Likert scale. Results: The study cohort included 568 patients (289 [50.9%] men; mean [SD] age, 70.5 [16.1] years) who died in the hospital or were discharged to hospice. Sepsis was present in 300 hospitalizations (52.8%; 95% CI, 48.6%-57.0%) and was the immediate cause of death in 198 cases (34.9%; 95% CI, 30.9%-38.9%). The next most common immediate causes of death were progressive cancer (92 [16.2%]) and heart failure (39 [6.9%]). The most common underlying causes of death in patients with sepsis were solid cancer (63 of 300 [21.0%]), chronic heart disease (46 of 300 [15.3%]), hematologic cancer (31 of 300 [10.3%]), dementia (29 of 300 [9.7%]), and chronic lung disease (27 of 300 [9.0%]). Hospice-qualifying conditions were present on admission in 121 of 300 sepsis-associated deaths (40.3%; 95% CI 34.7%-46.1%), most commonly end-stage cancer. Suboptimal care, most commonly delays in antibiotics, was identified in 68 of 300 sepsis-associated deaths (22.7%). However, only 11 sepsis-associated deaths (3.7%) were judged definitely or moderately likely preventable; another 25 sepsis-associated deaths (8.3%) were considered possibly preventable. Conclusions and Relevance: In this cohort from 6 US hospitals, sepsis was the most common immediate cause of death. However, most underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care. Further innovations in the prevention and care of underlying conditions may be necessary before a major reduction in sepsis-associated deaths can be achieved

Injury Incidence and Prevalence in a Sample of Wrestlers Based in Britain: A Retrospective Study Journal of Elite Sport Performance

Background and Aim Britain has competed in Freestyle Wrestling since it first featured in the Olympic Games in 1904 and the Commonwealth Games in 1930. Despite Britain’s long history with the sport, there are currently no studies that have aimed to quantify injury incidence and prevalence. Therefore, the aim of this study was to estimate the injury incidence and prevalence in a sample of wrestlers based in Britain. Methods A self-reported, cross-sectional study design was used. All participants were registered British Wrestling Association Club members and had at least 12 months of prior wrestling experience. Data was collected via a questionnaire offered to participants in both online and paper format at the English Wrestling Championships 2022 and via coaches from each British wrestling club. Injury incidence was calculated by estimating injuries /1000 athletic exposures (AE). Injury site, type, mechanism and severity were measured. One variable chi-square tests (X2) were used to calculate if observed values were significantly different from expected values. Results One hundred and forty-six (n=146) wrestlers (30.1 ± 8.6 years, 85.4 ± 15.6 kg, 176.6 ±10.37cm) completed the injury survey. Over 12 months, the participants sustained one hundred and ninety-five (n= 195) injuries, equating to an average of 1.3 ± 1.2 per participant. The overall incidence rate was 3.40/1000 AE (95% CI 3.16 to 3.6). The competition injury incidence of 42.01/1000 AE (95% CI 26.97 to 57.05) and 2.92/1000 AE (95% CI 2.69 to 3.14) for wrestling training activities. The knee was the most common injury site, accounting for 26.1% of all injuries, whilst strains or sprains occurred most often (36.3%). Takedowns were the leading mechanism of injury (36.4%), and most injuries were categorised as slight (28.7%). Conclusions This is the first study to estimate the prevalence, severity, and mechanism of injury in Wrestlers based in Britain. Data is comparable to previous studies in American high school and college wrestlers. Future studies should consider a medically reported method to confirm these results further. Practical Implications The reported data from this study allows for the development of injury risk reduction strategies by region and injury type

Local In Vivo measures of Muscle Lipid and Oxygen Consumption Change in Response to Combined Vitamin D Repletion and Aerobic Training in Older Adults

Intramyocellular (IMCL), extramyocellular lipid (EMCL), and vitamin D deficiency are associated with muscle metabolic dysfunction. This study compared the change in [IMCL]:[EMCL] following the combined treatment of vitamin D and aerobic training (DAT) compared with vitamin D (D), aerobic training (AT), and control (CTL). Male and female subjects aged 60–80 years with a BMI ranging from 18.5–34.9 and vitamin D status of ≤ 32 ng/mL (25(OH)D) were recruited to randomized, prospective clinical trial double-blinded for supplement with a 2 × 2 factorial design. Cholecalciferol (Vitamin D3) (10,000 IU × 5 days/week) or placebo was provided for 13 weeks and treadmill aerobic training during week 13. Gastrocnemius IMCL and EMCL were measured with magnetic resonance spectroscopy (MRS) and MRI. Hybrid near-infrared diffuse correlation spectroscopy measured hemodynamics. Group differences in IMCL were observed when controlling for baseline IMCL (p = 0.049). DAT was the only group to reduce IMCL from baseline, while a mean increase was observed in all other groups combined (p = 0.008). IMCL reduction and the corresponding increase in rVO2 at study end (p = 0.011) were unique to DAT. Vitamin D, when combined with exercise, may potentiate the metabolic benefits of exercise by reducing IMCL and increasing tissue-level VO2 in healthy, older adults

Disposable Patterned Electroceutical Dressing (PED-10) Is Safe for Treatment of Open Clinical Chronic Wounds

Objective: To evaluate if patterned electroceutical dressing (PED) is safe for human chronic wounds treatment as reported by wound care providers. Approach: This work reports a pilot feasibility study with the primary objective to determine physically observable effects of PED application on host tissue response from a safety evaluation point of view. For this pilot study, patients receiving a lower extremity amputation with at least one open wound on the part to be amputated were enrolled. Patients were identified through the Ohio State University Wexner Medical Center (OSUWMC) based on inclusion and exclusion criteria through prescreening through the Comprehensive Wound Center's (CWC) Limb Preservation Program and wound physicians and/or providers at OSUWMC. Wounds were treated with the PED before amputation surgery. Results: The intent of the study was to identify if PED was safe for clinical application based on visual observations of adverse or lack of adverse events on skin and wound tissue. The pilot testing performed on a small cohort (N = 8) of patients showed that with engineered voltage regulation of current flow to the open wound, the PED can be used with little to no visually observable adverse effects on chronic human skin wounds. Innovation: The PED was developed as a second-generation tunable electroceutical wound care dressing, which could potentially be used to treat wounds with deeper infections compared with current state of the art that treats wounds with treatment zone limited to the surface near topical application. Conclusion: Technology advances in design and fabrication of electroceutical dressings were leveraged to develop a tunable laboratory prototype that could be used as a disposable low-cost electroceutical wound care dressing on chronic wounds. Design revisions of PED-1 (1 kΩ ballast resistor) circumvented previously observed adverse effects on the skin in the vicinity of an open wound. PED-10 (including a 10 kΩ ballast resistor) was well tolerated in the small cohort of patients (N = 8) on whom it was tested, and the observations reported here warrant a larger study to determine the clinical impact on human wound healing and infection control

Ecological risk assessment for deep-sea mining

Ecological risk assessment for deep-sea mining is challenging, given the data-poor state of knowledge of deep-sea ecosystem structure, process, and vulnerability. Polling and a scale-intensity-consequence approach (SICA) were used in an expert elicitation survey to rank risk sources and perceived vulnerabilities of habitats associated with seabed nodule, sulfide, and crust mineral resources. Experts identified benthic habitats associated with seabed minerals as most vulnerable to habitat removal with a high degree of certainty. Resource-associated benthic and pelagic habitats were also perceived to be at risk from plumes generated during mining activities, although there was not always consensus regarding vulnerabilities to specific risk sources from different types of plumes. Even for risk sources where habitat vulnerability measures were low, high uncertainties suggest that these risks may not yet be dismissed. Survey outcomes also underscore the need for risk assessment to progress from expert opinion with low certainty to data-rich and ecosystem-relevant scientific research assessments to yield much higher certainty. This would allow for design and deployment of effective precautionary and mitigation efforts in advance of commercial exploitation, and adaptive management strategies would allow for regulatory and guideline modifications in response to new knowledge and greater certainty

Understanding the Uptown Triangle Neighborhood: Mapping Quality of Life Indicators in the Black Pearl

In the spring of 2015, University of New Orleans (UNO) students enrolled in the MURP 4081/5081 course-Applied Geographic Information Systems: Information Technology for the Planning Profession (also known as ‘Applied GIS’) led by Dr. Michelle Thompson. Since 2008 this course has provided students with a blended experience with learning the theory and receiving an introduction to spatial analysis using the Environmental Systems Research Institute (ESRI) ArcGIS software then applying this knowledge as GIS Analysts with a non-profit community partner. In the fall of 2014, Dr. Thompson competed to have this course designated as the inaugural Department of Planning and Urban Studies (PLUS) service learning course. By January 2015, Thompson developed a scope of services and formed a partnership with the Uptown Triangle Neighborhood Association (UTNA) to evaluate Quality of Life Indicators limited to the evaluation of property, road, and storm drain conditions. The Uptown Triangle Neighborhood (UTN), which was formerly known as the ‘Black Pearl’, is a triangular shaped neighborhood and is bounded by Street Charles Avenue, Broadway Avenue, and Leake Avenue. Prior to the UTNA study, Graham Hayes – UTNA Board Member, UT resident, former WhoData Intern and Bachelor of Science in Urban Studies Program’14 graduate, had developed a series of datasets and crowdsourced data through resident and volunteer activities from spring to early fall 2014. The GIS Mapping Analysts collected primary and integrated secondary data to provide the results of their study in this report. Within the same project, a separate team of novice GIS Programming Analysts developed, tested with the GIS Mapping Analysts and deployed a web-enabled data collection application known as the ‘WhoData Map App.’ The goal of this project and the goal of the client, is to create a tool that will empower members of the neighborhood to advocate community involvement in decision making for the Uptown Triangle Neighborhood. It will also provide a strategic resource for members of the community to evaluate future conditions that may impact the quality of life for those that live there

Lactate-Dehydrogenase 5 is overexpressed in non-small cell lung cancer and correlates with the expression of the transketolase-like protein 1

<p>Abstract</p> <p>Aims</p> <p>As one of the five Lactate dehydrogenase (LDH) isoenzymes, LDH5 has the highest efficiency to catalyze pyruvate transformation to lactate. LDH5 overexpression in cancer cells induces an upregulated glycolytic metabolism and reduced dependence on the presence of oxygen. Here we analyzed LDH5 protein expression in a well characterized large cohort of primary lung cancers in correlation to clinico-pathological data and its possible impact on patient survival.</p> <p>Methods</p> <p>Primary lung cancers (n = 269) and non neoplastic lung tissue (n = 35) were tested for LDH5 expression by immunohistochemistry using a polyclonal LDH5 antibody (ab53010). The results of LDH5 expression were correlated to clinico-pathological data as well as to patient's survival. In addition, the results of the previously tested Transketolase like 1 protein (TKTL1) expression were correlated to LDH5 expression.</p> <p>Results</p> <p>89.5% (n = 238) of NSCLC revealed LDH5 expression whereas LDH5 expression was not detected in non neoplastic lung tissues (n = 34) (p < 0.0001). LDH5 overexpression was associated with histological type (adenocarcinoma = 57%, squamous cell carcinoma = 45%, large cell carcinoma = 46%, p = 0.006). No significant correlation could be detected with regard to TNM-stage, grading or survival. A two sided correlation between the expression of TKTL1 and LDH5 could be shown (p = 0.002) within the overall cohort as well as for each grading and pN group. A significant correlation between LDH5 and TKTL1 within each histologic tumortype could not be revealed.</p> <p>Conclusions</p> <p>LDH5 is overexpressed in NSCLC and could hence serve as an additional marker for malignancy. Furthermore, LDH5 correlates positively with the prognostic marker TKTL1. Our results confirm a close link between the two metabolic enzymes and indicate an alteration in the glucose metabolism in the process of malignant transformation.</p