Cell-free DNA and outcome in sepsis.

Severe sepsis can be a catastrophic condition that is often associated with poor outcomes. The early diagnosis and management of the condition are vital in order to improve the chances of survival. However, owing to the syndromal nature of its definition and the lack of a biomarker able to accurately confirm the condition, the diagnosis of sepsis is challenging. Even more challenging is the prediction of how these patients will respond to the therapy and whether they will survive the intensive care and the hospital admission

What role does the right side of the heart play in circulation?

Right ventricular failure (RVF) is an underestimated problem in intensive care. This review explores the physiology and pathophysiology of right ventricular function and the pulmonary circulation. When RVF is secondary to an acute increase in afterload, the picture is one of acute cor pulmonale, as occurs in the context of acute respiratory distress syndrome, pulmonary embolism and sepsis. RVF can also be caused by right myocardial dysfunction. Pulmonary arterial catheterization and echocardiography are discussed in terms of their roles in diagnosis and treatment. Treatments include options to reduce right ventricular afterload, specific pulmonary vasodilators and inotropes

Innovation in the energy sector: advancing or frustrating climate policy goals?

The energy sector is well known for the relatively modest level of resource that it devotes to research and development (R&D). However, the incremental pace of energy innovation has speeded up in the last decade as measured by public sector R&D budgets, deployment of alternative technologies and novel institutional arrangements. While much of this effort has been targeted at technologies that promise to reduce carbon dioxide (CO2) emissions, there have also been major innovations that extend the fossil fuel resource base and reduce the cost of extraction. The last decade’s developments can be seen in terms of a challenge to the existing energy paradigm in parallel with a renewed innovative response focusing on conventional fuels and technologies. This paper examines this tension, by exploring the expectations of a variety of organisations in both the public and private sector regarding energy sector developments and by analysing private sector expenditure on energy research and development (R&D) and public sector budgets for energy R&D and demonstration (RD&D). Scenarios and outlook exercises that have been published since 2013 reveal a wide range of beliefs about the future development of the energy system. The contrasting views underpinning the different scenarios are reflected in divergent patterns of R&D investment between the private and public sectors. There appears to be a tension between the drive to transform energy systems, on the part of public bodies, mainly motivated by the need to combat global climate change, and private sector activity, which tends to reinforce and extend existing patterns of energy provision. The paper addresses, but not answer definitively, the key question as to whether technological change is enabling or frustrating ambitious carbon goals

Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies - with specific reference to the measurement of cardiac output

Bland-Altman analysis is used for assessing agreement between two measurements of the same clinical variable. In the field of cardiac output monitoring, its results, in terms of bias and limits of agreement, are often difficult to interpret, leading clinicians to use a cutoff of 30% in the percentage error in order to decide whether a new technique may be considered a good alternative. This percentage error of ± 30% arises from the assumption that the commonly used reference technique, intermittent thermodilution, has a precision of ± 20% or less. The combination of two precisions of ± 20% equates to a total error of ± 28.3%, which is commonly rounded up to ± 30%. Thus, finding a percentage error of less than ± 30% should equate to the new tested technique having an error similar to the reference, which therefore should be acceptable. In a worked example in this paper, we discuss the limitations of this approach, in particular in regard to the situation in which the reference technique may be either more or less precise than would normally be expected. This can lead to inappropriate conclusions being drawn from data acquired in validation studies of new monitoring technologies. We conclude that it is not acceptable to present comparison studies quoting percentage error as an acceptability criteria without reporting the precision of the reference technique

Vibrational relaxation measurements in CO2 USING an induced fluorescence technique

Vibrational relaxation measurements in carbon dioxide using induced infrared fluorescence techniqu

Underperforming policy networks : the biopesticides network in the United Kingdom

Loosely integrated and incomplete policy networks have been neglected in the literature. They are important to consider in terms of understanding network underperformance. The effective delivery and formulation of policy requires networks that are not incomplete or underperforming. The biopesticides policy network in the United Kingdom is considered and its components identified with an emphasis on the lack of integration of retailers and environmental groups. The nature of the network constrains the actions of its agents and frustrates the achievement of policy goals. A study of this relatively immature policy network also allows for a focus on network formation. The state, via an external central government department, has been a key factor in the development of the network. Therefore, it is important to incorporate such factors more systematically into understandings of network formation. Feedback efforts from policy have increased interactions between productionist actors but the sphere of consumption remains insufficiently articulated