Survival and recovery modeling of acute kidney injury in critically ill adults

Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I–III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (p-value \u3c 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1–22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14–39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention

On the existence of solutions to the relativistic Euler equations in 2 spacetime dimensions with a vacuum boundary

We prove the existence of a wide class of solutions to the isentropic relativistic Euler equations in 2 spacetime dimensions with an equation of state of the form $p=K\rho^2$ that have a fluid vacuum boundary. Near the fluid vacuum boundary, the sound speed for these solutions are monotonically decreasing, approaching zero where the density vanishes. Moreover, the fluid acceleration is finite and bounded away from zero as the fluid vacuum boundary is approached. The existence results of this article also generalize in a straightforward manner to equations of state of the form $p=K\rho^\frac{\gamma+1}{\gamma}$ with $\gamma > 0$.Comment: A major revision of the second half of the pape

Frequency of Injuries from Line Entanglements, Killer Whales, and Ship Strikes on Bering-Chukchi-Beaufort Seas Bowhead Whales

We analyzed scarring data for Bering-Chukchi-Beaufort (BCB) Seas bowhead whales (Balaena mysticetus) harvested by Alaska Native hunters to quantify the frequency of line entanglement, ship strikes, and killer whale-inflicted injuries. We had 904 records in our database for whales landed between 1990 and 2012, and after data quality screening, we found 521 records containing information on scarring. Logistic regression was used to evaluate different combinations of explanatory variables (i.e., body length, sex, year, year-group) to develop a prediction model for each scar type. We also list bowhead whales that were harvested, found dead, or observed alive entangled in commercial line/fishing gear. Our findings suggest that about 12% of harvested bowheads show entanglement scars. Their frequency is highly correlated with body length and sex: about 50% of very large bowheads (> 17 m) show such scars, while whales under 9 m rarely do, and males show a significantly higher rate than females. Scars associated with ship strikes are infrequent and occur on ~2% of all harvested whales; body length, sex, and year were not significant factors. Scarring from attempted killer whale predation was evident on ~8% of landed whales. As with entanglement injuries, the frequency of killer whale scars was much higher (> 40%) on whales more than 16 m in length and statistically more frequent in the second half of the study (2002 – 12). Increased killer whale injuries in the recent decade are consistent with studies conducted on bowheads of the Eastern Canada-West Greenland population. The findings presented here reflect the most thorough analysis of injury rates from entanglement, ships, and killer whales for the BCB bowheads conducted to date. They indicate that (1) entanglement rates primarily from pot fishing gear (crab or cod or both) are relatively high for very large and presumably older bowheads, (2) collisions with ships are infrequent at present, and (3) scarring from killer whales is frequent on very large adult whales (> 17 m). Considering that bowhead habitat is changing rapidly (e.g., sea ice reduction), industrial ship traffic in the Arctic is increasing, and commercial fishing operations are expanding to the north, we strongly recommend that monitoring of scarring and injuries on harvested bowheads continue into the future as a means of documenting change.Nous avons analysé les données sur les cicatrices que portent les baleines boréales (Balaena mysticetus) des mers de Béring, des Tchouktches et de Beaufort capturées par des chasseurs autochtones de l’Alaska afin de quantifier la fréquence d’emmêlements dans des filets de pêche, de collisions avec des navires et de blessures infligées par des épaulards. Notre base de données contenait 904 enregistrements portant sur des baleines prises entre 1990 et 2012 et, après une sélection des données selon leur qualité, nous avons trouvé 521 enregistrements comptant de l’information sur des cicatrices. Une méthode de régression logistique a été utilisée pour évaluer différentes combinaisons de variables explicatives (longueur corporelle, sexe, année et année-groupe, par exemple) afin de concevoir un modèle prédictif pour chaque type de cicatrice. Nous énumérons également les baleines boréales retrouvées emmêlées dans des engins ou des filets de pêche commerciale qui ont été capturées, trouvées mortes ou observées vivantes. Nos découvertes suggèrent qu’environ 12 % des baleines boréales capturées portent des cicatrices causées par l’emmêlement. La fréquence des cicatrices est étroitement liée à la longueur corporelle et au sexe : environ 50 % des baleines boréales de très grande taille (> 17 m) montrent de telles cicatrices, tandis que les baleines mesurant moins de 9 m portent rarement de telles cicatrices. Par ailleurs, les mâles affichent beaucoup plus de cicatrices que les femelles. Les cicatrices reliées à des collisions avec des navires sont rares et n’apparaissent que sur environ 2 % de toutes les baleines capturées; la longueur corporelle, le sexe et l’année n’étaient pas des facteurs importants. Les cicatrices causées par des tentatives de prédation par les épaulards étaient apparentes sur environ 8 % des baleines prises. Comme pour les blessures causées par l’emmêlement, la fréquence des cicatrices causées par des épaulards était beaucoup plus élevée(> 40 %) sur les baleines mesurant plus de 16 m de longueur et statistiquement plus fréquente dans la deuxième partie de l’étude (2002–2012). L’augmentation des blessures causées par des épaulards au cours de la dernière décennie concorde avec les études réalisées sur la population des baleines boréales de l’est du Canada et de l’ouest du Groenland. Les résultats présentés dans cette étude reflètent l’analyse la plus profonde du taux de blessures causées par l’emmêlement, les navires et les épaulards sur les baleines boréales des mers de Béring, des Tchouktches et de Beaufort à avoir été réalisée jusqu’à présent. Les observations indiquent que : 1) le taux d’emmêlement découlant principalement des engins ou casiers de pêche (crabe ou morue ou les deux) est relativement élevé chez les baleines boréales de très grande taille et probablement plus vieilles, 2) les collisions avec les navires sont rares en ce moment, et 3) les cicatrices causées par des épaulards sont fréquentes chez les baleines adultes de très grande taille (> 17 m). Étant donné le changement rapide de l’habitat de la baleine boréale (diminution des glaces marines, par exemple), l’augmentation de la circulation maritime industrielle dans l’Arctique et l’intensification des opérations de pêche commerciale au nord, nous recommandons fortement de continuer de surveiller les cicatrices et les blessures des baleines boréales capturées afin de documenter les changements

Group-Based Parent Training Interventions for Parents of Children with Autism Spectrum Disorders: a Literature Review

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Parents of children with autism spectrum disorders should have access to interventions to help them understand and support their child. This literature review examines the existing evidence for group-based parent training interventions that support parents of children with autism. From the literature, core intervention processes and outcomes are identified and include parenting and parent behaviour, parent health, child behaviour and peer and social support. Results show a positive trend for intervention effectiveness, but findings are limited by low-quality studies and heterogeneity of intervention content, outcomes and outcome measurement. Future research should focus on specifying effective intervention ingredients and modes of delivery, consistent and reliable outcome measurement, and improving methodological rigour to build a more robust evidence base

20th to 21st Century Relative Sea and Land Level Changes in Northern California: Tectonic Land Level Changes and their Contribution to Sea-Level Rise, Humboldt Bay Region, Northern California

Sea-level changes are modulated in coastal northern California by land-level changes due to the earthquake cycle along the Cascadia subduction zone, the San Andreas plate boundary fault system, and crustal faults. Sea-level rise (SLR) subjects ecological and anthropogenic infrastructure to increased vulnerability to changes in habitat and increased risk for physical damage. The degree to which each of these forcing factors drives this modulation is poorly resolved. We use NOAA tide gage data and ‘campaign’ tide gage deployments, Global Navigation Satellite System (GNSS) data, and National Geodetic Survey (NGS) first-order levelling data to calculate vertical land motion (VLM) rates in coastal northern California. Sea-level observations, highway level surveys, and GNSS data all confirm that land is subsiding in Humboldt Bay, in contrast to Crescent City where the land is rising. Subtracting absolute sea-level rate (~1.99 mm/year) from Crescent City (CC) and North Spit (NS) gage relative sea-level rates reveals that CC is uplifting at ~2.83 mm/year and NS is subsiding at ~3.21mm/year. GNSS vertical deformation reveals similar rates of ~2.60 mm/year of uplift at Crescent City. In coastal northern California, there is an E-W trending variation in vertical land motion that is primarily due to Cascadia megathrust fault seismogenic coupling. This interseismic subsidence also dominates the N-S variation in vertical land motion in most of the study region. There exists a second-order heterogeneous N-S trend in vertical land motion that we associate to crustal fault-related strain. There may be non-tectonic contributions to the observed VLM rates

The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty

‘Get yourself some nice, neat, matching box files’: research administrators and occupational identity work

To date, qualitative research into occupational groups and cultures within academia has been relatively scarce, with an almost exclusive concentration upon teaching staff within universities and colleges. This article seeks to address this lacuna and applies the interactionist concept of ‘identity work’ in order to examine one specific group to date under-researched: graduate research administrators. This occupational group is of sociological interest as many of its members appear to span the putative divide between ‘academic’ and ‘administrative’ occupational worlds within higher education. An exploratory, qualitative research project was undertaken, based upon interviews with 27 research administrators. The study analyses how research administrators utilise various forms of identity work to sustain credible occupational identities, often in the face of considerable challenge from their academic colleagues