Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU.

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Measuring the orientation of a single CdSe/CdS nanocrystal at the end of a near-field tip for the realization of a versatile active SNOM probe

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Photon-correlation Fourier spectroscopy of the trion fluorescence in thick-shell CdSe/CdS nanocrystals

International audienceThe emission spectrum of the trion state in very thick shell CdSe/CdS nanocrystals is characterized at 4 K by photon correlation Fourier spectroscopy. A value of 50 μeV for the width of the zero phonon line is measured. The absence of blinking and the high photostability of these emitters offer the possibility to investigate the dynamics of the emission spectrum at a time scale as short as 250 ns. We show that the high value of the linewidth (50 μeV) is not due to spectral diffusion induced by the close environment of the emitter at time scales larger than 250 ns. The broadening is attributed to the additional third carrier when compared to the monoexcitonic state

Bragg gratings inscription in highly birefringent microstructured POFs

FINEP - FINANCIADORA DE ESTUDOS E PROJETOSWe report for the first time, the fast inscription of high-quality Bragg gratings in highly birefringent microstructured polymer optical fibers by the phase mask method using 248-nm UV radiation. The fibers birefringence is created through a special design of the structure of holes through the fiber. A Bragg grating in these type of fibers allows the creation of two reflection peaks, where the peak separation is related to the phase birefringence.We report for the first time, the fast inscription of high-quality Bragg gratings in highly birefringent microstructured polymer optical fibers by the phase mask method using 248-nm UV radiation. The fibers birefringence is created through a special design of the structure of holes through the fiber. A Bragg grating in these type of fibers allows the creation of two reflection peaks, where the peak separation is related to the phase birefringence.286621624FINEP - FINANCIADORA DE ESTUDOS E PROJETOSFINEP - FINANCIADORA DE ESTUDOS E PROJETOS112039300This work was supported in part by National Funds through the FCT-Fundacao para a Ciencia e Tecnologia under Project PEst-OE/EEI/LA0008/2013 and scholarships (SFRH/BD/88472/2012 and SFRH/BPD/78205/2011), and in part by FINEP under Project 0112039300. The development of mPOF structure 1 was financed by the Wroclaw Research Centre EIT+

Significant decrease of the optical losses in the coupling between colloidal CdSe/CdS nanocrystals and a flat gold film at cryogenic temperature

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