The Great Flood: An Exploration of Fluid Resuscitation in Sepsis

Sepsis and septic shock continue to be major causes of in-hospital mortality. The World Health Organization (WHO) declared sepsis as a global health top priority as of 2017. To combat sepsis mortality, the Surviving Sepsis Campaign (SSC) released the first set of guidelines in 2004 and continues to publish treatment guidelines, updating the guidelines every four years based on emerging evidence. The 2018 update to the 2016 guidelines contains an Hour-1 Bundle released by the SSC, which includes a rapid infusion of a 30 ml/kg fluid bolus as a strong recommendation with low quality evidence. Recently, studies have challenged this recommendation, demonstrating complications due to fluid overload when following the guideline. This continues to be a source of controversy, as the fluid bolus is included in the Centers for Medicare and Medicaid Services SEP-1 performance measure, requiring healthcare practitioners to administer the bolus despite the risks of harm. A literature review was conducted utilizing PubMed to explore the following question: in adult patients with sepsis or septic shock, does initially administering at least 30 ml/kg of fluid improve morbidity and mortality compared to other treatment modalities, such as a fluid restrictive approach or early introduction of vasopressors? The null hypothesis was that there would be no difference amongst treatment modalities. This review revealed that giving a standard 30 ml/kg fluid bolus may be harmful, potentially leading to poorer outcomes. Alternative fluid administration approaches are discussed

The anomalous threshold, confinement, and an essential singularity in the heavy-light form factor

The analytic behavior of the heavy-light meson form factor is investigated using several relativistic examples including unconfined, weakly confined, and strongly confined mesons. It is observed that confinement erases the anomalous threshold singularity and also induces an essential singularity at the normal annihilation threshold. In the weak confinement limit, the "would be" anomalous threshold contribution is identical to that of the real singularity on its space-like side.Comment: Latex 2.09 with epsf.sty. 24 pages of text and 8 postscript figures. Postscript version of complete paper will also be available soon at http://phenom.physics.wisc.edu/pub/preprints/1997/madph-97-983 or at ftp://phenom.physics.wisc.edu/pub/preprints/1997/madph-97-98

Nyintroduktioner på Aktietorget - En genväg till bättre avkastning

Syftet med denna uppsats är att studera vilka variabler som historiskt sett har spelat störst roll för en positiv initial kursförändring när bolag har listats på Aktietorget. Författarna vill genom att studera dessa variabler, komma fram till vilka av dem som har en påverkan på den initiala kursförändringen och därmed konstruera en mall för vilken typ av bolag som vid listning på Aktietorget får en positiv initial kursförändring. Studien har en deduktiv ansats och använder sig av en kvantitativ metod. Efter att ha genomfört undersökningen kunde författarna konstatera att den genomsnittliga initiala kursförändringen i urvalet av företag var 21 procent. Författarna lyckas därmed uppfylla uppsatsens syfte, då man påvisar vilka variabler som har ett samband med uppgång. Utifrån de empiriska resultaten kunde en investeringsmall konstrueras och uppsättningen variabler en investerare ska söka efter är: - Låg teckningskurs - Hög Market to book-ratio - Unga företag - Introduktioner på onsdaga

An Industry Experiment of Academic Performance and Drop-out in Gamified Distance Education

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Development of new all-optical signal regeneration technique

All-optical signal regeneration have been the active research area since last decade due to evolution of nonlinear optical signal processing. Existing all-optical signal regeneration techniques are agitated in producing low Bit Error Rate (BER) of 10-10 at below than -10 dBm power received. In this paper, a new all-optical signal regeneration technique is developed by using phase sensitive amplification and designed optical phase locked signal mechanism. The developed all-optical signal regeneration technique is tested for different 10 Gb/s Differential Phase Shift Keying degraded signals. It is determined that the designed all-optical signal regeneration technique is able to provide signal regeneration with noise mitigation for degraded signals. It is analyzed that overall, for all degraded test signals, average BER of 10-13 is achieved at received power of -14 dBm. The designed technique will be helpful to enhance the performance of existing signal regeneration systems in the presence of severe noise by providing minimum BER at low received power

Structure and performance of zeolite supported Pd for complete methane oxidation

The influence of zeolite support materials and their impact on CH oxidation activity was studied utilizing Pd supported on H-beta and H-SSZ-13. A correlation between CH oxidation activity, Si/Al ratio (SAR), the type of zeolite framework, reduction-oxidation behaviour, and Pd species present was found by combining catalytic activity measurements with a variety of characterization methods (operando XAS, NH -TPD, SAXS, STEM and NaCl titration). Operando XAS analysis indicated that catalysts with high CH oxidation activity experienced rapid transitions between metallic- and oxidized-Pd states when switching between rich and lean conditions. This behaviour was exhibited by catalysts with dispersed Pd particles. By contrast, the formation of ion-exchanged Pd and large Pd particles appeared to have a detrimental effect on the oxidation-reduction behaviour and the conversion of CH . The formation of ion-exchanged Pd and large Pd particles was limited by using a highly siliceous beta zeolite support with a low capacity for cation exchange. The same effect was also found using a small-pore SSZ-13 zeolite due to the lower mobility of Pd species. It was found that the zeolite support material should be carefully selected so that the well-dispersed Pd particles remain, and the formation of ion-exchanged Pd is minimized. 4 4 3 4 4 2+ 2+ 2

Inhibiting metabotropic glutamate receptor 5 after stroke restores brain function and connectivity

Stroke results in local neural disconnection and brain-wide neuronal network dysfunction leading to neurological deficits. Beyond the hyper-acute phase of ischaemic stroke, there is no clinically-approved pharmacological treatment that alleviates sensorimotor impairments. Functional recovery after stroke involves the formation of new or alternative neuronal circuits including existing neural connections. The type-5 metabotropic glutamate receptor (mGluR5) has been shown to modulate brain plasticity and function and is a therapeutic target in neurological diseases outside of stroke. We investigated whether mGluR5 influences functional recovery and network reorganization rodent models of focal ischaemia. Using multiple behavioural tests, we observed that treatment with negative allosteric modulators (NAMs) of mGluR5 (MTEP, fenobam and AFQ056) for 12 days, starting 2 or 10 days after stroke, restored lost sensorimotor functions, without diminishing infarct size. Recovery was evident within hours after initiation of treatment and progressed over the subsequent 12 days. Recovery was prevented by activation of mGluR5 with the positive allosteric modulator VU0360172 and accelerated in mGluR5 knock-out mice compared with wild-type mice. After stroke, multisensory stimulation by enriched environments enhanced recovery, a result prevented by VU0360172, implying a role of mGluR5 in enriched environment-mediated recovery. Additionally, MTEP treatment in conjunction with enriched environment housing provided an additive recovery enhancement compared to either MTEP or enriched environment alone. Using optical intrinsic signal imaging, we observed brain-wide disruptions in resting-state functional connectivity after stroke that were prevented by mGluR5 inhibition in distinct areas of contralesional sensorimotor and bilateral visual cortices. The levels of mGluR5 protein in mice and in tissue samples of stroke patients were unchanged after stroke. We conclude that neuronal circuitry subserving sensorimotor function after stroke is depressed by a mGluR5-dependent maladaptive plasticity mechanism that can be restored by mGluR5 inhibition. Post-acute stroke treatment with mGluR5 NAMs combined with rehabilitative training may represent a novel post-acute stroke therapy