To dose or not to dose: that is the (starch) question ...

The present study describes the impact on renal function of a modern starch used for resuscitation in the intensive care unit. The role of starch in renal dysfunction, the importance of the definition of acute kidney injury and acute renal failure, and hyperoncoticity are reviewed

Endotracheal Intubation: The Role of Sterility

Background: There is a paucity of data regarding whether sterile handling of endotracheal tubes (ETTs) impacts the incidence and prevalence of pneumonia in the emergency, urgent, or elective clinical scenarios. Intensive care units employ infection control and reduction schemes to reduce pneumonia rates. Methods: A MEDLINE search of the English-language literature for the last 30 years was performed using the keywords “endotracheal intubation,” “intubation,” “pneumonia,” “sinusitis,” “tracheobronchitis,” “nosocomial infection,” and “infection.” Data were limited to those papers addressing the role of sterile handling or passage of ETTs, infection with antibiotic-resistant micro-organisms, antibiotic prophylaxis, and the role of virulence determinants in supporting invasive infection. Also, a convenience sample of a single author's patients requiring tracheal intubation was undertaken. Data were acquired on tube handling, success of insertion, and subsequent occurrence of pneumonia. Results: Virtually no data exist on the impact of sterile ETT handling, but unsterile manipulation of the ETT prior to insertion is common (112 of 154 intubation events). Within the limited patient sample, no conclusions may be drawn regarding the impact of unsterile handling on pneumonia rates, although sinusitis after nasotracheal intubation clearly increases the incidence of pneumonia. Biofilm generation as a facilitator of bacterial colonization of artificial airway surfaces is a ubiquitous virulence determinant that is not ameliorated by antibiotic administration. Conclusions: Unsterile ETT handling and insertion techniques are not clearly associated with pneumonia induction, but physiologically sound approaches that retard biofilm production may decrease pneumonia rates.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63193/1/sur.2006.054.pd

Type I Interferons Are Associated with Subclinical Markers of Cardiovascular Disease in a Cohort of Systemic Lupus Erythematosus Patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94405/1/Somers_2012_Type_I_Interferons_subclinical_markers.pdf165

Rich Situated Attitudes

We outline a novel theory of natural language meaning, Rich Situated Semantics [RSS], on which the content of sentential utterances is semantically rich and informationally situated. In virtue of its situatedness, an utterance’s rich situated content varies with the informational situation of the cognitive agent interpreting the utterance. In virtue of its richness, this content contains information beyond the utterance’s lexically encoded information. The agent-dependence of rich situated content solves a number of problems in semantics and the philosophy of language (cf. [14, 20, 25]). In particular, since RSS varies the granularity of utterance contents with the interpreting agent’s informational situation, it solves the problem of finding suitably fine- or coarse-grained objects for the content of propositional attitudes. In virtue of this variation, a layman will reason with more propositions than an expert

Social determinants of content selection in the age of (mis)information

Despite the enthusiastic rhetoric about the so called \emph{collective intelligence}, conspiracy theories -- e.g. global warming induced by chemtrails or the link between vaccines and autism -- find on the Web a natural medium for their dissemination. Users preferentially consume information according to their system of beliefs and the strife within users of opposite narratives may result in heated debates. In this work we provide a genuine example of information consumption from a sample of 1.2 million of Facebook Italian users. We show by means of a thorough quantitative analysis that information supporting different worldviews -- i.e. scientific and conspiracist news -- are consumed in a comparable way by their respective users. Moreover, we measure the effect of the exposure to 4709 evidently false information (satirical version of conspiracy theses) and to 4502 debunking memes (information aiming at contrasting unsubstantiated rumors) of the most polarized users of conspiracy claims. We find that either contrasting or teasing consumers of conspiracy narratives increases their probability to interact again with unsubstantiated rumors.Comment: misinformation, collective narratives, crowd dynamics, information spreadin

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study

Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90 days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41-0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11-0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts

Impossible worlds

Impossible worlds are representations of impossible things and impossible happenings. They earn their keep in a semantic or metaphysical theory if they do the right theoretical work for us. As it happens, a worlds-based account provides the best philosophical story about semantic content, knowledge and belief states, cognitive significance and cognitive information, and informative deductive reasoning. A worlds-based story may also provide the best semantics for counterfactuals. But to function well, all these accounts need use of impossible and as well as possible worlds. So what are impossible worlds? Graham Priest claims that any of the usual stories about possible worlds can be told about impossible worlds, too. But far from it. I'll argue that impossible worlds cannot be genuine worlds, of the kind proposed by Lewis, McDaniel or Yagisawa. Nor can they be ersatz worlds on the model proposed by Melia or Sider. Constructing impossible worlds, it turns out, requires novel metaphysical resources