96 research outputs found
Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation
Background: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is
able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if
functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO2AT) could identify these patients.
Methods: Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed
CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial
applanation tonometry were performed.
Results: There were 70 participants (age 41.7614.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were
desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced
anaerobic threshold (VO2AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27â0.68; p,0.001) and
in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12â0.59; p = 0.001). The area under the receiveroperating-
characteristic curve was 0.93, based on a risk prediction model that incorporated VO2AT, body mass index and
desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU
admission.
Conclusions: To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a
preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO2AT has the
potential to predict perioperative morbidity in kidney transplant recipients
The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis
Objective: The Surviving Sepsis Campaign (SSC or âthe Campaignâ) 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 âbundledâ into two sets of targets to be completed within 6Â h and within 24Â 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 2Â years (PÂ <Â 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 2Â years (PÂ =Â 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 2Â years (PÂ =Â 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 2Â years (95% CI, 2.5â8.4%). 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
Genetic mechanisms of critical illness in COVID-19.
Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, PÂ =Â 1.65Â ĂÂ 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, PÂ =Â 2.3Â ĂÂ 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, PÂ =Â 3.98Â ĂÂ Â 10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, PÂ =Â 4.99Â ĂÂ 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice
Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity
The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)
A História da Alimentação: balizas historiogråficas
Os M. pretenderam traçar um quadro da HistĂłria da Alimentação, nĂŁo como um novo ramo epistemolĂłgico da disciplina, mas como um campo em desenvolvimento de prĂĄticas e atividades especializadas, incluindo pesquisa, formação, publicaçÔes, associaçÔes, encontros acadĂȘmicos, etc. Um breve relato das condiçÔes em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biolĂłgica, a econĂŽmica, a social, a cultural e a filosĂłfica!, assim como da identificação das contribuiçÔes mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histĂłrica, foi ela organizada segundo critĂ©rios morfolĂłgicos. A seguir, alguns tĂłpicos importantes mereceram tratamento Ă parte: a fome, o alimento e o domĂnio religioso, as descobertas europĂ©ias e a difusĂŁo mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rĂĄpido balanço crĂtico da historiografia brasileira sobre o tema
Well Played -- Vol. 7, No. 2
<p>iThrive Games Founderâs Letter<br> Dorothy N. Batten</p>
<p>Introduction to the Special Issue: Thriving Through Gameplay<br> Susan E. Rivers</p>
<p>Prosocial Religion and Games: Lost & Found<br> Owen Gottlieb and Ian Schreiber</p>
<p>Skazka: Exploring Empathy Through Cooperative Mechanics and Narrative<br> Sarah A. Abraham</p>
<p>GUIDE and Dangerous Play: An Empathetic Game About Coping and Resilience<br> Rebecca Goodine, Jade A. Yhap, and Jeffrey T. Mundee</p>
<p>Butterfly Lovers: Design Rationale of a Cooperative Virtual Reality Game for Promoting Compassion in Multigenerational Families<br> Jessica Cheng, Sydney Rubin, Christina Lelon, Xian Lu, Jeffrey Doan, Patrick Bender, Ashley Yu-Chih, Brenda Chen, Nathan Lim, Gabrielle Kanellos, Kelsey Rice, Maryalice Jordan-Marsh, & Marientina Gotsis</p>
<p>Kisima InĆitchuĆa (Never Alone) As Cultural Survivance: The Potential of Video Games to Support Indigenous Well-being<br> Jennifer C. Stone</p>
<p>Beyond Empathy: Games to Foster Teensâ Social and Emotional Skills<br> Kelli N. Dunlap & Susan E. Rivers</p
Journal of Games, Self, & Society, Issue 1
A peer-reviewed journal created and edited by iThrive Games and published by ETC Press. JGSS encourages interdisciplinary research, conversation, and community around games-related scholarship. The journal highlights work focused on how games, game design, and gameplay contribute to a deeper understanding of learning, health, and humanity. - American Abyss: Simulating a Modern American Civil War Edward Castronova, PhD - When the Mind Moves Freely, the Body Follows: Exergame Design, Evaluation, and the Curious Case of Pokémon GO Kathleen Yin, BPharm, PhD and Matthew D. Lee, RN, MS - Using Games to Support STEM Curiosity, Identity, and Self-Efficacy Lindsay Portnoy, PhD and Karen Schrier, PhD - Playing Against Abuse: Effects of Procedural and Narrative Persuasive Games Ruud S. Jacobs PhD, Jeroen Jansz PhD, and Julia Kneer PhD</div
- âŠ