Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Blood stream infections (BSI) are life-threatening infections in intensive care units (ICU), and prognosis is highly dependent on early detection. Procalcitonin levels have been shown to accurately and quickly distinguish between BSI and noninfectious inflammatory states in critically ill patients. It is, however, unknown to what extent a recent history of sepsis (namely, secondary sepsis) can affect diagnosis of BSI using PCT.</p> <p>Methods</p> <p>review of the medical records of every patient with BSI in whom PCT dosage at the onset of sepsis was available between 1^stSeptember, 2006 and 31^stJuly, 2007.</p> <p>Results</p> <p>179 episodes of either primary (<it>n </it>= 117) or secondary (<it>n </it>= 62) sepsis were included. Procalcitonin levels were found to be markedly lower in patients with secondary sepsis than in those without (6.4 [9.5] vs. 55.6 [99.0] ng/mL, respectively; <it>p </it>< 0.001), whereas the SOFA score was similar in the two groups. Although patients in the former group were more likely to have received steroids and effective antibiotic therapy prior to the BSI episode, and despite a higher proportion of candidemia in this group, a low PCT value was found to be independently associated with secondary sepsis (Odd Ratio = 0.33, 95% Confidence Interval: 0.16–0.70; <it>p </it>= 0.004). Additional patients with suspected but unconfirmed sepsis were used as controls (<it>n </it>= 23). Thus, diagnostic accuracy of PCT as assessed by the area under the receiver-operating characteristic curves (AUROCC) measurement was decreased in the patients with secondary sepsis compared to those without (AUROCC = 0.805, 95% CI: 0.699–0.879, vs. 0.934, 95% CI: 0.881–0.970, respectively; <it>p </it>< 0.050).</p> <p>Conclusion</p> <p>In a critically ill patient with BSI, PCT elevation and diagnosis accuracy could be lower if sepsis is secondary than in those with a first episode of infection.</p

Suicidality among adolescents engaging in nonsuicidal self-injury (NSSI) and firesetting: The role of psychosocial characteristics and reasons for living

Background: Co-occurrence of problem behaviors, particularly across internalizing and externalizing spectra, increases the risk of suicidality (i.e., suicidal ideation and attempt) among youth. Methods: We examined differences in psychosocial risk factors across levels of suicidality in a sample of 77 school-based adolescents engaging in both nonsuicidal self-injury (NSSI) and repeated firesetting. Participants completed questionnaires assessing engagement in problem behaviors, mental health difficulties, negative life events, poor coping, impulsivity, and suicidality. Results: Adolescents endorsing suicidal ideation reported greater psychological distress, physical and sexual abuse, and less problem solving/goal pursuit than those with no history of suicidality; adolescents who had attempted suicide reported more severe NSSI, higher rates of victimization and exposure to suicide, relative to those with suicidal ideation but no history of attempt. Additional analyses suggested the importance of coping beliefs in protecting against suicidality. Conclusions: Clinical implications and suggestions for future research relating to suicide prevention are discussed

Isolation in Globalizing Academic Fields: A Collaborative Autoethnography of Early Career Researchers

This study examines academic isolation – an involuntary perceived separation from the academic field to which one aspires to belong, associated with a perceived lack of agency in terms of one’s engagement with the field – as a key challenge for researchers in increasingly globalized academic careers. While prior research describes early career researchers’ isolation in their institutions, we theorize early career researchers’ isolation in their academic fields and reveal how they attempt to mitigate isolation to improve their career prospects. Using a collaborative autoethnographic approach, we generate and analyze a dataset focused on the experiences of ten early career researchers in a globalizing business academic field known as Consumer Culture Theory. We identify bricolage practices, polycentric governance practices, and integration mechanisms that work to enhance early career researchers’ perceptions of agency and consequently mitigate their academic isolation. Our findings extend discussions on isolation and its role in new academic careers. Early career researchers, in particular, can benefit from a deeper understanding of practices that can enable them to mitigate isolation and reclaim agency as they engage with global academic fields

The contribution of the Framework Programmes to major innovations

This report presents the overall findings of the Study on Contribution of the Framework Programmes to Major Innovations (N° RTD-Major Innovations-2013-A5). The aim of the project is to evaluate the contribution of the European research programmes (FP5, FP6 and FP7) to the development of a selected number of Major Innovations. The focus of the study is on the identification of the key elements explaining the factors and conditions that brought the respective Major Innovation about, and the contribution of the EU funded research. The results of the study are targeted for supporting the policy evaluation and understanding of the areas for further improvement. The study has analysed different cases and their wider context in detail. The main conclusions drawn for the analysis can be summarised as follows: 1. Research and Development, although important, is one of many drivers for major innovations and despite the fact that the FP’s have not directly contributed to breakthroughs in the Major Innovations, they have significantly contributed to the relevant innovative capacity of firms, fostering the wider innovation environment (e.g. clusters and value chains), and to related incremental innovations. 2. Major Innovations usually consist of so-called families of innovations, which together are a necessary condition to make the innovation happen. Each of the innovation families has a different “ownership”, pace and timing to be mature enough to enter the market. (The recent extension to “closer to market” activities in Horizon 2020 offers opportunities for further synchronization). 3. The exploratory and excellence driven nature of FP5 to FP7 aimed at pre-competitive research (TRL 1-4), whereas 8 out of 10 Major Innovations passed TRL9. This implies that much of the results of the FP’s may contribute to the Major Innovations through networking, aligning agendas, knowledge creation and diffusion in relevant families of innovations and to understanding the more general framework conditions for an innovation. 4. Major Innovations strongly depend on a high impact of policies and regulations outside of the specific R&D&I domain (for instance the telecom liberalization, energy policies or the GPS Dual use policy). The FPs have helped to create conditions and potential pathways to leverage such policies into Major Innovations