Statin therapy in critical illness : an international survey of intensive care physicians' opinions, attitudes and practice

Background Pleotropic effects of statins on inflammation are hypothesised to attenuate the severity of and possibly prevent the occurrence of the host inflammatory response to pathogen and infection-related acute organ failure. We conducted an international survey of intensive care physicians in Australia, New Zealand (ANZ) and United Kingdom (UK). The aims of the survey were to assess the current prescribing practice patterns, attitudes towards prescribing statin therapy in critically ill patients and opinions on the need for an interventional trial of statin therapy in critically ill patients. Methods Survey questions were developed through an iterative process. An expert group reviewed the resulting 26 items for face and content validity and clarity. The questions were further refined following pilot testing by ICU physicians from Australia, Canada and the UK. We used the online Smart SurveyTM software to administer the survey. Results Of 239 respondents (62 from ANZ and 177 from UK) 58% worked in teaching hospitals; most (78.2%) practised in ‘closed’ units with a mixed medical and surgical case mix (71.0%). The most frequently prescribed statins were simvastatin (77.6%) in the UK and atorvastatin (66.1%) in ANZ. The main reasons cited to explain the choice of statin were preadmission prescription and pharmacy availability. Most respondents reported never starting statins to prevent (65.3%) or treat (89.1%) organ dysfunction. Only a minority (10%) disagreed with a statement that the risks of major side effects of statins when prescribed in critically ill patients were low. The majority (84.5%) of respondents strongly agreed that a clinical trial of statins for prevention is needed. More than half (56.5%) favoured rates of organ failure as the primary outcome for such a trial, while a minority (40.6%) favoured mortality. Conclusions Despite differences in type of statins prescribed, critical care physicians in the UK and ANZ reported similar prescription practices. Respondents from both communities agreed that a trial is needed to test whether statins can prevent the onset of new organ failure in patients with sepsis

Millimeter Wave Localization: Slow Light and Enhanced Absorption

We exploit millimeter wave technology to measure the reflection and transmission response of random dielectric media. Our samples are easily constructed from random stacks of identical, sub-wavelength quartz and Teflon wafers. The measurement allows us to observe the characteristic transmission resonances associated with localization. We show that these resonances give rise to enhanced attenuation even though the attenuation of homogeneous quartz and Teflon is quite low. We provide experimental evidence of disorder-induced slow light and superluminal group velocities, which, in contrast to photonic crystals, are not associated with any periodicity in the system. Furthermore, we observe localization even though the sample is only about four times the localization length, interpreting our data in terms of an effective cavity model. An algorithm for the retrieval of the internal parameters of random samples (localization length and average absorption rate) from the external measurements of the reflection and transmission coefficients is presented and applied to a particular random sample. The retrieved value of the absorption is in agreement with the directly measured value within the accuracy of the experiment.Comment: revised and expande

Centre of pressure, vertical ground reaction forces and neuromuscular responses of special-forces soldiers to 43km load carriage in the field

The primary purpose of this study was to examine lateral deviations in centre of pressure as a result of an extreme duration load carriage task, with particular focus on heel contact. Twenty (n=17 males, n=3 females) soldiers from a Special Operation Forces unit (body mass: 80.72±21.49kg; stature:178.25±8.75cm; age: 26±9yrs) underwent gait plantar pressure assessment and vertical jump testing before and after a 43km load carriage event (duration 817.02[32.66]min) carrying a total external load of 29.80 (1.05)kg. Vertical jump height decreased by 18.62%±16.85% (0.30±0.08m to 0.24±0.07m) p<.001. Loading peak and mid stance force minimum were significantly increased after load carriage (2.59±0.51BW vs. 2.81±0.61BW; p=.035; dGlass=0.44 and 1.28±0.40BW vs. 1.46±0.41BW; p=.015 dGlass=0.45, respectively) and increases in lateral centre of pressure displacement were observed as a result of the load carriage task 14.64±3.62mm to 16.97 ±3.94mm p<.029. In conclusion, load carriage instigated a decrease in neuromuscular function alongside increases in ground reaction forces associated with injury risk and centre of pressure changes associated with ankle sprain risk. Practitioners should consider that possible reduction in ankle stability remains even once the load had been removed, suggesting soldiers are still at increased risk of injury even once the load has been removed

Outcomes of interfacility critical care adult patient transport: a systematic review

INTRODUCTION: We aimed to determine the adverse events and important prognostic factors associated with interfacility transport of intubated and mechanically ventilated adult patients. METHODS: We performed a systematic review of MEDLINE, CENTRAL, EMBASE, CINAHL, HEALTHSTAR, and Web of Science (from inception until 10 January 2005) for all clinical studies describing the incidence and predictors of adverse events in intubated and mechanically ventilated adult patients undergoing interfacility transport. The bibliographies of selected articles were also examined. RESULTS: Five studies (245 patients) met the inclusion criteria. All were case-series and two were prospective in design. Due to the paucity of studies and significant heterogeneity in study population, outcome events, and results, we synthesized data in a qualitative manner. Pre-transport severity of illness was reported in only one study. The most common indication for transport was a need for investigations and/or specialist care (three studies, 220 patients). Transport modalities included air (fixed or rotor wing; 66% of patients) and ground (31%) ambulance, and commercial aircraft (3%). Transport teams included a physician in three studies (220 patients). Death during transfer was rare (n = 1). No other adverse events or significant therapeutic interventions during transport were reported. One study reported a 19% (28/145) incidence of respiratory alkalosis on arrival and another study documented a 30% overall intensive care unit mortality, while no adverse events or outcomes were reported after arrival in the three other studies. CONCLUSION: Insufficient data exist to draw firm conclusions regarding the mortality, morbidity, or risk factors associated with the interfacility transport of intubated and mechanically ventilated adult patients. Further study is required to define the risks and benefits of interfacility transfer in this patient population. Such information is important for the planning and allocation of resources related to transporting critically ill adults

Differential Response of Bacterial Microdiversity to Simulated Global Change

ACKNOWLEDGMENTS UC Irvine and the LRGCE are located on the ancestral homelands of the Indigenous Kizh and Acjachemen nations. We thank Alejandra Rodriguez Verdugo, Katrine Whiteson, Kendra Walters, Cynthia Rodriguez, Kristin Barbour, Alberto Barron Sandoval, Joanna Wang, Joia Kai Capocchi, Pauline Uyen Phuong Nguyen, Khanh Thuy Huynh, and Clara Barnosky for their input on analyses and previous drafts and for laboratory help. This work was supported by the U.S. Department of Energy, Office of Science, Office of Biological and Environmental Research grants DE-SC0016410 and DE-SC0020382.Peer reviewedPublisher PD

Hemophilia gene therapy knowledge and perceptions: Results of an international survey

Background Hemophilia gene therapy is a rapidly evolving therapeutic approach in which a number of programs are approaching clinical development completion. Objective The aim of this study was to evaluate knowledge and perceptions of a variety of health care practitioners and scientists about gene therapy for hemophilia. Methods This survey study was conducted February 1 to 18, 2019. Survey participants were members of the ISTH, European Hemophilia Consortium, European Hematology Association, or European Association for Hemophilia and Allied Disorders with valid email contacts. The online survey consisted of 36 questions covering demographic information, perceptions and knowledge of gene therapy for hemophilia, and educational preferences. Survey results were summarized using descriptive statistics. Results Of the 5117 survey recipients, 201 responded from 55 countries (4% response rate). Most respondents (66%) were physicians, and 59% were physicians directly involved in the care of people with hemophilia. Among physician respondents directly involved in hemophilia care, 35% lacked the ability to explain the science of adeno-associated viral gene therapy for hemophilia, and 40% indicated limited ability or lack of comfort answering patient questions about gene therapy for hemophilia based on clinical trial results to date. Overall, 75% of survey respondents answered 10 single-answer knowledge questions correctly, 13% incorrectly, and 12% were unsure of the correct answers. Conclusions This survey highlighted knowledge gaps and educational needs related to gene therapy for hemophilia and, along with other inputs, has informed the development of "Gene Therapy in Hemophilia: An ISTH Education Initiative.

Comparison of Care Patterns and Rehospitalizations for Mechanically Ventilated Patients in New York and Ontario

Rationale: Mechanically ventilated patients require complex care and are at high risk for rehospitalization, but different systems of care may result in different hospital discharge practices and rates of rehospitalization. Objectives: To compare lengths of hospitalization, discharge patterns, and rehospitalization rates in New York (NY) in the US and Ontario (ON) in Canada. Methods: We conducted a retrospective cohort study of mechanically ventilated patients who survived an acute care hospitalization in NY or ON from 2010-2012, using linkable administrative healthcare data. Measurements and Main Results: The primary outcome was the cumulative incidence of first rehospitalization within 30 days of discharge, accounting for the competing risk of death. Of 71,063 mechanically ventilated patients in NY, and 41,875 in ON who survived to hospital discharge, median length of initial hospital stay was similar in NY versus ON (15 days, Interquartile range (IQR) 8-28 vs 16 (9-30)), but was systematically shorter in NY when stratified by patient subgroups of different illness severity. Fewer patients in NY were discharged directly home (53.6% versus 71.4%). Of patients in NY, 15,527 (cumulative incidence 21.9%) had a first rehospitalization within 30 days versus 5,531 (cumulative incidence 13.2%) in Ontario, p<0.001. Incidence of rehospitalization was higher in NY across all subgroups assessed, with the greatest differences among patients with a tracheostomy (29.8% versus 13.3%, p<0.001), those who received dialysis during the hospitalization (31.9% versus 17.0%, p<0.001), and for patients not discharged directly home (27.6% versus 13.1% p<0.001). Conclusions: Mechanically ventilated patients who survive to hospital discharge in NY have shorter hospital stays, with higher rehospitalization rates within 30 days compared with ON

The design and development of a third generation OSEE instrument

Optically Stimulated Electron Emission (OSEE) has been used to quantify surface contamination in the aerospace community. As advances are made towards the understanding of OSEE, it is desirable to incorporate technological advances with succeeding generations of instrumentation, so that improvements in the practical application of OSEE may be disseminated among the user community. Several studies undertaken by Yost, Welch, Abedin and others have expanded the knowledge base related to the underlying principles of OSEE. The conclusions of these studies, together with inputs from the user community were the foundation upon which the development of a third generation OSEE instrument was based. This manuscript describes the significant improvements incorporated into a third generation OSEE instrument as well as the elements unique to its design

Pneumonia identification using nursing home records

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research