613 research outputs found

    Neutrophil CD64 as a marker of infection in patients admitted to the emergency department with acute respiratory failure

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    Introduction: Cluster of differentiation 64 (CD64) is expressed on neutrophils during bacterial infections and sepsis. The aim of our study was to assess the CD64 expression in patients admitted to the emergency department (ED) with a triage diagnosis of acute respiratory failure (ARF) and/or dyspnea and to verify a relationship between its value and the presence of infection. Methods: We assessed neutrophil CD64 expression in peripheral blood of patients admitted to the ED with a diagnosis of ARF and/or dyspnea from September 2012 to April 2013. We mea- sured CD64 index by flow cytometry (Leuko64TM kit) and classified patients as infected within 12 hours from admission, without an infection within 12 hours but infected within 72 hours from admission, and not infected. The primary outcome was differentiating CD64 values of patients with a diagnosis of infection within 12 hours and 72 hours from admission, from those of patients without a diagnosis of infection. The secondary outcome was verifying a relationship between CD64 values and patients’ characteristics, Sequential Organ Failure Assessment score, and intensive care unit admission. Results: Of 212 patients included in the study, 40.1% were classified as infected within 12 hours from admission, 20.3% were without an infection 12 hours after admission but were infected within 72 hours, and 39.6% were not infected. The median CD64 index was higher in patients with an infection on admission (CD64 index: 3.58) than in those not considered infected (CD64 index: 1.37), P,0.0001. Among patients not infected at admission, the CD64 index was higher in those with an infection detected during the following hours of observation (CD64 index: 2.75) than in patients without a diagnosis of infection (CD64 index: 1.28), P,0.0001. A CD64 index .3.65 showed a sensitivity of 94.6%, a specificity of 86.8%, and an area under the receiver-operating characteristic curve of 0.952 for prediction of intensive care unit admission. Conclusion: CD64 index could represent a useful diagnostic tool for differential diagnosis of ARF in the ED

    Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study

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    High-fidelity simulation (HFS) is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS), in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge) and an objective section (measuring level of knowledge) containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test) with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2) than in group C (mean 65.5, SD 14.3), p = 0.0017, 95% C.I. 3.34 - 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22-5.99) and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13-6.53). Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074). A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079). HFS showed a beneficial effect on knowledge of ALS among medical students, especially for notions of algorithms and team working/early warning scores/communication

    Extending gravitational wave extraction using Weyl characteristic fields

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    We present a detailed methodology for extracting the full set of Newman-Penrose Weyl scalars from numerically generated spacetimes without requiring a tetrad that is completely orthonormal or perfectly aligned to the principal null directions. We also describe how to implement an extrapolation technique for computing the Weyl scalars’ contribution at asymptotic null infinity in postprocessing. These methods have been used to produce ι₄ and ℎ waveforms for the Simulating eXtreme Spacetimes (SXS) waveform catalog and now have been expanded to produce the entire set of Weyl scalars. These new waveform quantities are critical for the future of gravitational wave astronomy in order to understand the finite-amplitude gauge differences that can occur in numerical waveforms. We also present a new analysis of the accuracy of waveforms produced by the Spectral Einstein Code. While ultimately we expect Cauchy characteristic extraction to yield more accurate waveforms, the extraction techniques described here are far easier to implement and have already proven to be a viable way to produce production-level waveforms that can meet the demands of current gravitational-wave detectors

    Renal hemodynamics and fatty acid uptake: effects of obesity and weight loss

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    Human studies of renal hemodynamics and metabolism in obesity are insufficient. We hypothesized that renal perfusion and renal free fatty acid (FFA) uptake are higher in subjects with morbid obesity compared with lean subjects and that they both decrease after bariatric surgery. Cortical and medullary hemodynamics and metabolism were measured in 23 morbidly obese women and 15 age- and sex-matched nonobese controls by PET scanning of [O-15]-H2O (perfusion) and 14(R,S)-[F-18]fluoro-6-thia-heptadecanoate (FFA uptake). Kidney volume and radiodensity were measured by computed tomography, cardiac output by MRI. Obese subjects were re-studied 6 mo after bariatric surgery. Obese subjects had higher renal volume but lower radiodensity, suggesting accumulation of water and/or lipid. Both cardiac output and estimated glomerular filtration rate (eGFR) were increased by similar to 25% in the obese. Total renal blood flow was higher in the obese [885 (317) (expressed as median and interquartile range) vs. 749 (300) (expressed as means and SD) ml/min of controls, P = 0.049]. In both groups, regional blood perfusion was higher in the cortex than medulla; in either region, FFA uptake was similar to 50% higher in the obese as a consequence of higher circulating FFA levels. Following weight loss (26 +/- 8 kg), total renal blood flow was reduced (P = 0.006). Renal volume, eGFR, cortical and medullary FFA uptake were decreased but not fully normalized. Obesity is associated with renal structural, hemodynamic, and metabolic changes. Six months after bariatric surgery, the hemodynamic changes are reversed and the structural changes are improved. On the contrary, renal FFA uptake remains increased, driven by high substrate availability
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