Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy

Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.BackgroundCritical illness leading to multi-organ dysfunction syndrome (MODS) and associated acute renal failure (ARF) is less common in children compared to adult patients. As a result, many issues plague the pediatric ARF outcome literature, including a relative lack of prospective study, a lack of modality stratification in subject populations and inconsistent controls for patient illness severity in outcome analysis.MethodsWe now report data from the first multicenter study to assess the outcome of pediatric patients with MODS receiving continuous renal replacement therapy (CRRT). One hundred twenty of 157 Registry patients (63 male/57 female) experienced MODS during their course.ResultsOne hundred sixteen patients had complete data available for analysis. The most common causes leading to CRRT were sepsis (N = 47; 39.2%) and cardiogenic shock (N = 24; 20%). Overall survival was 51.7%. Pediatric Risk of Mortality (PRISM 2) score, central venous pressure (CVP), and% fluid overload (%FO) at CRRT initiation were significantly lower for survivors versus nonsurvivors. Multivariate analysis controlling for severity of illness using PRISM 2 at CRRT initiation revealed that%FO was still significantly lower for survivors versus nonsurvivors (P < 0.05) even for patients receiving both mechanical ventilation and vasoactive pressors. We speculate that increased fluid administration from PICU admission to CRRT initiation is an independent risk factor for mortality in pediatric patients with MODS receiving CRRT.ConclusionWe suggest that after initial resuscitative efforts, an increased emphasis should be placed on early initiation of CRRT and inotropic agent use over fluid administration to maintain acceptable blood pressure

New games, new rules: big data and the changing context of strategy

Big data and the mechanisms by which it is produced and disseminated introduce important changes in the ways information is generated and made relevant for organizations. Big data often represents miscellaneous records of the whereabouts of large and shifting online crowds. It is frequently agnostic, in the sense of being produced for generic purposes or purposes different from those sought by big data crunching. It is based on varying formats and modes of communication (e.g., texts, image and sound), raising severe problems of semiotic translation and meaning compatibility. Crucially, the usefulness of big data rests on their steady updatability, a condition that reduces the time span within which this data is useful or relevant. Jointly, these attributes challenge established rules of strategy making as these are manifested in the canons of procuring structured information of lasting value that addresses specific and long-term organizational objectives. The developments underlying big data thus seem to carry important implications for strategy making, and the data and information practices with which strategy has been associated. We conclude by placing the understanding of these changes within the wider social and institutional context of longstanding data practices and the significance they carry for management and organizations

Preliminary assessment of the effects of biaxial loading on reactor pressure vessel structural-integrity-assessment technology

Effects of biaxial loading on shallow-flaw fracture toughness were studied to determine potential impact on structural integrity assessment of a reactor pressure vessel (RPV) under pressurized thermal shock (PTS) transient loading and pressure-temperature (PT) loading produced by reactor heatup and cooldown transients. Biaxial shallow-flaw fracture-toughness tests results were also used to determine the parameter controlling fracture in the transition temperature range, and to develop a related dual-parameter fracture-toughness correlation. Shallow-flaw and biaxial loading effects were found to reduce the conditional probability of crack initiation by a factor of nine when the shallow-flaw fracture-toughness K{sub Jc} data set, with biaxial-loading effects adjustments, was substituted in place of ASME Code K{sub Ic} data set in PTS analyses. Biaxial loading was found to reduce the shallow-flaw fracture toughness of RPV steel such that the lower-bound curve was located between ASME K{sub Ic} and K{sub IR} curves. This is relevant to future development of P-T curve analysis procedures. Fracture in shallow-flaw biaxial samples tested in the lower transition temperature range was shown to be strain controlled. A strain-based dual-parameter fracture-toughness correlation was developed and shown to be capable of predicting the effect of crack-tip constraint on fracture toughness for strain-controlled fracture

Chylothorax after high translumbar aortography

Chlothorax is a rare complication of high translumbar aortography and a case is described here