The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

Objective: The Surviving Sepsis Campaign (SSC or “the Campaign”) developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. Design and setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were “bundled” into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. Main results: Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P < 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years (P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5–8.4%). Conclusions: The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1738-3) contains supplementary material, which is available to authorized users

Differences between Tethered Polyelectrolyte Chains on Bare Mica and Hydrophobically Modified Mica

This study investigates the structures of layers of amphiphilic diblock copolymers of poly(t-butyl styrene)-poly- (styrene sulfonate) (PtBS-PSS) adsorbed on both the bare mica surface (hydrophilic) and an octadecyltriethoxysilane (OTE)-modified mica surface (hydrophobic). When the surface is rendered hydrophobic, the nonsoluble block exhibits stronger interaction with the surface and higher adsorbed masses are achieved. Interaction forces between two such adsorbed layers on both substrates were measured using the surface forces apparatus. The effect of salt concentration (Cs) and molecular weight (N) on the height of the self-assembled layers (L0) was examined in each case. The resulting scaling relationship is in good agreement with predictions of the brush model, L0 ∞ N1.0 in the low-salt limit and L0N-1 ∞ (Cs/σ)-0.32 in the salted regime, when adsorption takes place onto the hydrophobized mica surface. For adsorption on the bare mica surface, L0N-0.7 ∞ Cs -0.17 agrees with the scaling prediction of the sparse tethering model. The results suggest that, on the hydrophilic bare mica surface, the adsorbed amount is not high enough to form a brush structure and only very little intermolecular stretching of the tethered chains occurs; in contrast, the presence of the hydrophobic OTE layer increases the tethering density such that the polyelectrolyte chains adopt a brush conformation

Crystallographic study of phases present in CuInSe2 absorber layers produced by laser annealing co-electrodeposited precursors

For the production of high efficiency thin film, Cu In,Ga Se2 solar cells, absorber layers with grain sizes of a few hundred nanometers and without detrimental secondary phases are favored. Co electrodeposition offers a low cost and material efficient synthesis route, where, in a single step, films containing CuInSe2 are formed. However, the material is nanocrystalline, constitutes multiple phases and has poor photovoltaic properties. Therefore a subsequent annealing step is required to produce absorber layers suitable for use in photovoltaic devices. Laser annealing has been demonstrated to improve crystallinity, stimulate atomic diffusion and develop opto electronic properties when compared to the precursor. In this work, high resolution X ray diffraction was used in order to assess the presence of secondary phases in the absorber layer. All diffractograms of laser annealed films exhibited an additional, unknown peak, measurable through the full depth of the material which is independent of precursor composition, annealing time or laser flux. Evaluation of literature on codeposited CuInSe2, combined with Rietveld refinement suggests a number of possible identities for this peak. The candidates in order of most likely to least likely are structural defects, In2Se3, and CuIn3Se5. We consider the impact that each of these would have on a device formed via this process and thus its success as a new manufacturing route for CuInSe2 solar cell

The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy

Background: The optimal hemoglobin level and transfusion threshold in patients with septic shock treated with an early, goal oriented approach to resuscitation remains unknown. Aims: To assess the impact of packed red blood cell (PRBC) transfusion on clinically relevant outcomes in patients with septic shock treated with early goal directed therapy (EGDT). Settings and Design: Retrospective cohort study of 93 patients who presented with septic shock, to a single center academic intensive care unit and received EGDT. Materials and Methods: Data were collected on patients identified via the Surviving Sepsis Campaign Chart Review database and linked to Project IMPACT database. The PRBC group and no PRBC group were compared by the Pearson chi-square and Fisher\u2032s exact test to analyze statistical significance. Results: The PRBC group had a mortality of 41.2% vs. 33.9% in the no PRBC transfusion group (P = NS). The PRBC group also had more mechanical ventilation days (11.2 days vs. 5.0 days, P 64 0.05), longer hospital length of stay (25.9 days vs. 12.5 days, P 64 0.05), and longer intensive care unit length of stay (11.4 days vs. 3.8 days, P 64 0.05). Conclusions: In this retrospective cohort study, transfusion of PRBCs was associated with worsened clinical outcomes in patients with septic shock treated with EGDT. Further studies are needed to determine the impact of transfusion of PRBC within the context of early resuscitation of patients with septic shock, as the beneficial effects gained by an early and goal oriented approach to resuscitation may be lost by the negative effects associated with PRBC transfusion

The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy

Background: The optimal hemoglobin level and transfusion threshold in patients with septic shock treated with an early, goal oriented approach to resuscitation remains unknown. Aims: To assess the impact of packed red blood cell (PRBC) transfusion on clinically relevant outcomes in patients with septic shock treated with early goal directed therapy (EGDT). Settings and Design: Retrospective cohort study of 93 patients who presented with septic shock, to a single center academic intensive care unit and received EGDT. Materials and Methods: Data were collected on patients identified via the Surviving Sepsis Campaign Chart Review database and linked to Project IMPACT database. The PRBC group and no PRBC group were compared by the Pearson chi-square and Fisher′s exact test to analyze statistical significance. Results: The PRBC group had a mortality of 41.2% vs. 33.9% in the no PRBC transfusion group (P = NS). The PRBC group also had more mechanical ventilation days (11.2 days vs. 5.0 days, P ≤ 0.05), longer hospital length of stay (25.9 days vs. 12.5 days, P ≤ 0.05), and longer intensive care unit length of stay (11.4 days vs. 3.8 days, P ≤ 0.05). Conclusions: In this retrospective cohort study, transfusion of PRBCs was associated with worsened clinical outcomes in patients with septic shock treated with EGDT. Further studies are needed to determine the impact of transfusion of PRBC within the context of early resuscitation of patients with septic shock, as the beneficial effects gained by an early and goal oriented approach to resuscitation may be lost by the negative effects associated with PRBC transfusion

Discrimination and determination of secondary phases from a Cu2ZnSnS4 phase using X-ray diffraction and Raman spectroscopy

The formation of single phase Cu2ZnSnS4 thin films is known to be challenging, mainly due to the difficulties to detect secondary phases in the Cu2ZnSnS4 system. Here, the ability to quantitatively discriminate the most likely secondary phases ZnS and Cu2SnS3 from Cu2ZnSnS4 using common approaches but also using more complex and time consuming Rietveld refinement analysis techniques to analyse X ray diffractograms is investigated in a comparative study to the peak analysis of Raman spectra measured with standard conditions. In studying not only individual samples of the respective phases but also a phase gradient sample containing various amounts of Cu2SnS3 and ZnS alongside Cu2ZnSnS4, we found that refinement analyses can only discriminate more than 10 ZnS and 50 Cu2SnS3 from Cu2ZnSnS4, respectively. In comparison, Raman measurements performed with green wavelength excitation can discern more than 30 Cu2SnS3 from Cu2ZnSnS4 while ZnS is indiscernible. The results show that the identification of secondary phases in the Cu2ZnSnS4 system is more difficult than currently assumed in literature. Furthermore, the potential of multiple wavelength Raman spectroscopy as a tool to identify ZnS secondary phases is shown. Characterization of a Sn rich sample composition nearly Cu2ZnSn3S8 shows no sign of a Sn rich quaternary phase, questioning its existence under typical annealing condition