Neutropenic sepsis in the ICU: Outcome predictors in a two-phase model and microbiology findings

Objective. Patients with neutropenic sepsis have a poor prognosis. We aimed to identify outcome predictors and generate hypotheses how the care for these patients may be improved. Methods. All 12.352 patients admitted between 2006 and 2011 to the medical ICUs of our tertiary university center were screened for neutropenia; out of 558 patients identified, 102 fulfilled the inclusion criteria and were analyzed. Severity markers and outcome predictors were assessed. Results. The overall ICU mortality was 54.9%. The severity of sepsis and the number of organ failures predicted survival of the primary septic episode (APACHE II 22.8 and 29.0; SOFA 7.3 and 10.1, resp.). In the recovery phase, persistent organ damage and higher persistent C-reactive protein levels were associated with a poor outcome. Blood transfusions and CMV infection correlated with an unfavorable prognosis. Ineffective initial antibiotic therapy, fungal infections, and detection of multiresistant bacteria displayed a particularly poor outcome. Infections with coagulase-negative staphylococci and enterococci were associated with a significantly higher mortality and a high degree of systemic inflammation. Conclusion. Patients with persistent organ dysfunction show an increased mortality in the further course of their ICU stay. Early antimicrobial treatment of Gram-positive cocci may improve the outcome of these patients

Modification of radiation pressure due to cooperative scattering of light

Cooperative spontaneous emission of a single photon from a cloud of N atoms modifies substantially the radiation pressure exerted by a far-detuned laser beam exciting the atoms. On one hand, the force induced by photon absorption depends on the collective decay rate of the excited atomic state. On the other hand, directional spontaneous emission counteracts the recoil induced by the absorption. We derive an analytical expression for the radiation pressure in steady-state. For a smooth extended atomic distribution we show that the radiation pressure depends on the atom number via cooperative scattering and that, for certain atom numbers, it can be suppressed or enhanced.Comment: 8 pages, 2 Figure

Site 1220

Site 1220 (10°10.600´N, 142°45.503´W; 5218 meters below sea level (mbsl); Fig. F1) forms a southerly component of the 56-Ma transect drilled during Leg 199. It is situated about midway between the Clipperton and Clarion Fracture Zones in typical abyssal hill topography. On the basis of regional magnetic anomalies, we anticipated basement age at Site 1220 to be equivalent to Chron C25n (~56 Ma; Cande et al., 1989), slightly older than at Site 1219. At the outset of drilling at Site 1220, our estimate for total sediment depth was ~225 meters below seafloor (mbsf) (Fig. F2). Based upon a fixed hotspot model (Gripp and Gordon, 1990, for 0- to 5-Ma Pacific hotspot rotation pole; Engebretson et al., 1985, for older poles), Site 1220 should have been located ~3° south of the equator at 56 Ma and in an equatorial position at 40 Ma. Thus, Site 1220 should have been situated underneath the South Equatorial Current in the early Eocene. A nearby piston core (EW9709-13PC) taken during the site survey cruise recovered >16 m of red clay, with the base of the core dated as middle-early Miocene on the basis of radiolarian biostratigraphy (Lyle, 2000). Site 1220 will be used to study equatorial ocean circulation from the late Paleocene through the late Eocene during the early Cenozoic thermal maximum. Sediment records from this site will help to define the calcite compensation depth (CCD) and lysocline during the Paleocene-Eocene and Eocene-Oligocene transitions. In this and other respects, Site 1220 will act as an interesting analog to Site 1218. Both sites are thought to have been located on the equator at ~40 Ma, but the older crustal age anticipated at Site 1220 dictates a greater paleowater depth than for contemporaneous sediments accumulating at Site 1218

Site 1216

Site 1216 (21°27.16´N, 139°28.79´W; 5152 meters below sea level [mbsl]; Fig. F1) is situated in abyssal hill topography south of the Molokai Fracture Zone and two small associated unnamed parasitic fracture zones (Fig. F2). Based on magnetic lineations, Site 1216 appears to be situated on normal ocean crust formed during the C25r magnetic anomaly (~57 Ma; Atwater and Severinghaus, 1989). Site 1216 was chosen for drilling because it is near the thickest section of lower Eocene sediments along the 56-Ma transect, which was based upon the seismic stratigraphy of seismic reflection data acquired on site survey cruise EW9709 during transits between the proposed drill sites (Lyle et al., this volume; Moore et al., 2002). The Cenozoic history of sedimentation in this region was poorly constrained prior to Leg 199, being largely based on two Deep Sea Drilling Project (DSDP) drill sites (40 and 41) and piston core data (EW9709-3PC) from ~1.5° in latitude to the south. Based on data from these drill sites, we expected the sedimentary sequence at Site 1216 to comprise red clays (a mixture of wind-blown dust and authigenic precipitates) overlying a biogenic sediment section composed of an upper middle Eocene radiolarian ooze and lower carbonate ooze deposited when the site was near the ridge crest in the late Paleocene and early Eocene. The broad paleoceanographic objectives of drilling the sedimentary sequence anticipated at Site 1216 are as follows: (1) to help define the shift in the Intertropical Convergence Zone through the Paleogene by following the change in eolian-dust composition and flux through time (red clays) and (2) to help define the latitudinal extent, composition, and mass accumulation of plankton communities in the north equatorial Pacific region thereby constraining ocean circulation patterns and the extent of the equatorial high-productivity belt in the Eocene ocean. Results from Site 1216 will also provide important information to test whether there was significant motion of the Hawaiian hotspot with respect to the Earth's spin axis during the early Cenozoic. At 56 Ma, the backtracked location of Site 1216 based upon a hotspot reference frame (Gripp and Gordon, 1990, for 0- to 5-Ma Pacific hotspot rotation pole; Engebretson et al., 1985, for older poles) is about 9°N, 108°W. If significant hotspot motion or true polar wander occurred since 57 Ma (Petronotis et al., 1994), this drill site could have been much nearer to the equator

Site 1222

Site 1222 (13°48.98´N, 143°53.35´W; 4989 meters below sea level [mbsl]; Fig. F1) forms a south-central component of the 56-Ma transect drilled during Leg 199 and is situated ~2° south of the Clarion Fracture Zone in typical abyssal hill topography. On the basis of regional magnetic anomalies, we anticipated basement age at Site 1222 to be equivalent to Chron C25r or Chron C25n (~56-57 Ma) (Cande et al., 1989), which is slightly older than at Site 1219. At the outset of drilling at Site 1222, our estimate for total sediment thickness was ~115 m (Fig. F2). Based upon a fixed hotspot model (Gripp and Gordon, 1990, for 0- to 5-Ma Pacific hotspot rotation pole; Engebretson et al., 1985, for older poles) Site 1222 should have been located ~1° north of the equator at 56 Ma and ~4°N at 40 Ma. A nearby gravity core (EW9709-17GC), taken during the site survey cruise, recovered >5 m of red clay with a late-middle Miocene age on the basis of radiolarian biostratigraphy (Lyle, 2000). Deep Sea Drilling Project (DSDP) Site 42 located ~4° east of Site 1222, was not drilled to basement but contains a thin sedimentary section (~100 m thick) of upper Oligocene nannofossil ooze through middle Eocene radiolarian nannofossil ooze. In turn, DSDP Site 162 lies ~1° north of DSDP Site 42 and is situated on young crust (49 Ma) that contains ~150 m of clayey radiolarian and nannofossil oozes of early Oligocene-middle Eocene age. Site 1222 will be used to study the position of the Intertropical Convergence Zone in the late Eocene and Oligocene, to sample late Paleocene and early Eocene sediments in the central tropical Pacific Ocean, and to help determine whether or not there has been significant southward movement of the hotspots with respect to the spin axis prior to 40 Ma

Site 1217

Site 1217 (16°52.02´N, 138°06.00´W; 5342 meters below sea level [mbsl]; Fig. F1) is one of seven sites drilled to target upper Paleocene crust along a latitudinal transect during Leg 199 and will be used to investigate paleoceanographic processes in the northern tropical early Eocene Pacific Ocean. Site 1217 is situated ~1° north of the Clarion Fracture Zone on abyssal hill topography typical of the central Pacific. Based on magnetic lineations, basement age at Site 1217 should be in magnetic Anomaly C25r or ~57 Ma (Cande et al., 1989; timescale of Cande and Kent, 1995). The Cenozoic history of sedimentation in this region was poorly constrained prior to Leg 199 drilling because the nearest drill site (Deep Sea Drilling Project [DSDP] Site 162) is situated ~300 km south and west on 48-Ma crust. Based on data from this early rotary-cored hole, magnetic anomaly maps, a shallow-penetration piston core near Site 1217 (EW9709-4PC), and seismic profiling (Fig. F2), we expected the sedimentary sequence at Site 1217 to comprise a relatively thick (25 to 35 m thick) section of red clays overlying a radiolarian ooze and a basal carbonate section with possible chert near basement (estimated total depth ~125-150 meters below seafloor [mbsf]) deposited when the site was near the ridge crest in the late Paleocene and early Eocene. Site 1217 was chosen because it is anticipated to have been located just outside of the equatorial region at 56 Ma, ~5°N, 106°W based upon a fixed hotspot model (Gripp and Gordon, 1990, for 0- to 5-Ma Pacific hotspot rotation pole; Engebretson et al., 1985, for older poles). On the same basis at 40 Ma, the site was located at ~8°N, 111°W. Thus, Site 1217 should help define the paleoceanography of the northern tropical Pacific, in particular locating the ancient North Equatorial Countercurrent (NECC) region. General circulation-model experiments for the early Eocene (see Huber, this volume) suggest that the NECC was a well-developed current during this time period. Other paleoceanographic and paleoclimatic objectives of drilling the sedimentary sequence anticipated at Site 1217 are as follows: (1) to help define the shift in the Intertropical Convergence Zone through the Paleogene by following the change in eolian dust composition and flux through time (red clays); (2) to help constrain the middle-late Eocene calcite compensation depth (CCD); and (3) to sample the Paleocene/Eocene (P/E) boundary, one of the most climatologically critical intervals of Cenozoic time. Recovery of deep-sea sediments from this time interval during Leg 199 is a high priority because the P/E boundary has never before been sampled in the central tropical Pacific Ocean. Results from Site 1217 will also provide important information to test whether there was significant motion of the Hawaiian hotspot, with respect to the Earth's spin axis during the early Cenozoic. At 56 Ma, the backtracked location based upon a hotspot reference frame is ~5°N, 106°W, and at 40 Ma is ~8°N, 106°W. If significant hotspot motion or true polar wander occurred since 57 Ma (Petronotis et al., 1994), this drill site could have been much nearer to the equator

Geochemical analysis of bulk marine sediment by Inductively Coupled Plasma–Atomic Emission Spectroscopy on board the JOIDES Resolution

Geochemical analyses on board the JOIDES Resolution have been enhanced with the addition of a Jobin-Yvon Ultrace inductively coupled plasma-atomic emission spectrometer (ICP-AES) as an upgrade from the previous X-ray fluorescence facility. During Leg 199, we sought to both challenge and utilize the capabilities of the ICP-AES in order to provide an extensive bulk-sediment geochemical database during the cruise. These near real-time analyses were then used to help characterize the recovered sedimentary sequences, calculate mass accumulation rates of the different sedimentary components, and assist with cruise and postcruise sampling requests. The general procedures, sample preparation techniques, and basic protocol for ICP-AES analyses on board ship are outlined by Murray et al. (2000) in Ocean Drilling Program Tech Note, 29. We expand on those concepts and offer suggestions for ICP-AES methodology, calibration by standard reference materials, data reduction procedures, and challenges that are specific to the analysis of bulk-sediment samples. During Leg 199, we employed an extensive bulk-sediment analytical program of ~600 samples of varying lithologies, thereby providing several opportunities for refinement of techniques. We also discuss some difficulties and challenges that were faced and suggest how to alleviate such occurrences for sedimentary chemical analyses during future legs

Dynamical Coupling between a Bose-Einstein Condensate and a Cavity Optical Lattice

A Bose-Einstein condensate is dispersively coupled to a single mode of an ultra-high finesse optical cavity. The system is governed by strong interactions between the atomic motion and the light field even at the level of single quanta. While coherently pumping the cavity mode the condensate is subject to the cavity optical lattice potential whose depth depends nonlinearly on the atomic density distribution. We observe bistability already below the single photon level and strong back-action dynamics which tunes the system periodically out of resonance.Comment: 5 pages, 4 figure

The efficacy of topical imiquimod in high-grade cervical intraepithelial neoplasia:A systematic review and meta-analysis

Objective: A major side effect of cervical excision for high-grade cervical intraepithelial neoplasia (CIN) is premature birth. A non-invasive treatment for reproductive age women is warranted. The aim of the present study was to determine the efficacy of topical imiquimod in the treatment of high-grade CIN, defined as a regression to ≤CIN 1, and to determine the clearance rate of high-risk human papillomavirus (hr-HPV), compared with surgical treatment and placebo. Methods: Databases were searched for articles from their inception to February 2023.The study protocol number was INPLASY2022110046. Original studies reporting the efficacy of topical imiquimod in CIN 2, CIN 3 or persistent hr-HPV infections were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. Results: Five studies were included (n = 463). Histological regression to ≤CIN 1 was 55% in imiquimod versus 29% in placebo, and 93% in surgical treatment. Imiquimod-treated women had a greater odds of histological regression to ≤CIN 1 than placebo (odds ratio [OR] 4.17, 95% confidence interval [CI] 2.03–8.54). In comparison to imiquimod, surgical treatment had an OR of 14.81(95% CI 6.59–33.27) for histological regression to ≤CIN 1. The hr-HPV clearance rate was 53.4% after imiquimod and 66% after surgical treatment (95% CI 0.62–23.77). Conclusions: The histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.</p