The Effect of Hospital Volume on Mortality in Patients Admitted with Severe Sepsis

Importance The association between hospital volume and inpatient mortality for severe sepsis is unclear. Objective: To assess the effect of severe sepsis case volume and inpatient mortality. Design Setting and Participants Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011. Exposures The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles. Main Outcomes and Measures Inpatient mortality. Results: Compared with the highest tertile of severe sepsis volume (>60 cases per year), the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year) was 1.188 (95% CI: 1.074–1.315), while the odds ratio was 1.090 (95% CI: 1.031–1.152) for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64–38.03) for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51–32.64) for hospitals with the highest volume. Conclusions and Relevance We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients

In-depth description of Electrohydrodynamic conduction pumping of dielectric liquids: physical model and regime analysis

In this work, we discuss the fundamental aspects of Electrohydrodynamic (EHD) conduction pumping of dielectric liquids. We build a mathematical model of conduction pumping that can be applied to all sizes, down to microsized pumps. In order to do this, we discuss the relevance of the Electrical Double Layer (EDL) that appears naturally on nonmetallic substrates. In the process, we identify a new dimensionless parameter related to the value of the zeta potential of the substrate-liquid pair, which quantifies the influence of these EDLs on the performance of the pump. This parameter also describes the transition from EHD conduction pumping to electro-osmosis. We also discuss in detail the two limiting working regimes in EHD conduction pumping: ohmic and saturation. We introduce a new dimensionless parameter, accounting for the electric field enhanced dissociation that, along with the conduction number, allows us to identify in which regime the pump operates.Ministerio de Ciencia, Innovación y Universidades PGC2018-099217-B-I0

Dynamic and volumetric variables reliably predict fluid responsiveness in a porcine model with pleural effusion

Background: The ability of stroke volume variation (SVV), pulse pressure variation (PPV) and global end-diastolic volume (GEDV) for prediction of fluid responsiveness in presence of pleural effusion is unknown. The aim of the present study was to challenge the ability of SVV, PPV and GEDV to predict fluid responsiveness in a porcine model with pleural effusions. Methods: Pigs were studied at baseline and after fluid loading with 8 ml kg−1 6% hydroxyethyl starch. After withdrawal of 8 ml kg−1 blood and induction of pleural effusion up to 50 ml kg−1 on either side, measurements at baseline and after fluid loading were repeated. Cardiac output, stroke volume, central venous pressure (CVP) and pulmonary occlusion pressure (PAOP) were obtained by pulmonary thermodilution, whereas GEDV was determined by transpulmonary thermodilution. SVV and PPV were monitored continuously by pulse contour analysis. Results: Pleural effusion was associated with significant changes in lung compliance, peak airway pressure and stroke volume in both responders and non-responders. At baseline, SVV, PPV and GEDV reliably predicted fluid responsiveness (area under the curve 0.85 (p<0.001), 0.88 (p<0.001), 0.77 (p = 0.007). After induction of pleural effusion the ability of SVV, PPV and GEDV to predict fluid responsiveness was well preserved and also PAOP was predictive. Threshold values for SVV and PPV increased in presence of pleural effusion. Conclusions: In this porcine model, bilateral pleural effusion did not affect the ability of SVV, PPV and GEDV to predict fluid responsiveness

Squamous cell carcinoma of the breast: a case report

<p>Abstract</p> <p>Background</p> <p>Squamous cells are normally not found inside the breast, so a primary squamous cell carcinoma of the breast is an exceptional phenomenon. There is a possible explanation for these findings.</p> <p>Case presentation</p> <p>A 72-year-old woman presented with a breast abnormality suspected for breast carcinoma. After the operation the pathological examination revealed a primary squamous cell carcinoma of the breast.</p> <p>Conclusion</p> <p>The presentation of squamous cell carcinoma could be similar to that of an adenocarcinoma. However, a squamous cell carcinoma of the breast could also develop from a complicated breast cyst or abscess. Therefore, pathological examination of these apparent benign abnormalities is mandatory.</p

Long Wave Infrared Type II Superlattice Focal Plane Array Detector

The XBn/XBp family of barrier detectors enables diffusion limited dark currents comparable with HgxCd1-xTe Rule-07 and high quantum efficiencies. SCD’s XBp type II superlattice (T2SL) detector contains InAs/GaSb and InAs/AlSb T2SLs, and was designed for the long wave infrared (LWIR) atmospheric window using k · p based modeling of the energy bands and photo-response. Wafers are grown by molecular beam epitaxy and are fabricated into focal plane array (FPA) detectors using standard FPA processes, including wet and dry etching, indium bump hybridisation, under-fill, and back-side polishing. The 640 × 512 pixel, 15 μm pitch, detector goes by the name of ‘Pelican-D LW’ and exhibits a quantum efficiency of ~ 50 per cent with background limited performance at an operating temperature of 77 K. It has a cut-off wave length of ~ 9.5 μm, with a pixel operability of above 99 per cent. The detector gives a very stable image with a residual non uniformity of below 0.04 per cent over its useful dynamic range. A new digital read-out integrated circuit has been designed so that the complete detector closely follows the configuration of SCD’s MWIR Pelican-D detector

Performance Evaluation of the International Space Station Flow Boiling and Condensation Experiment (FBCE) Test Facility

A ground-based experimental facility to perform flow boiling and condensation experiments is built in support of the development of the long duration Flow Boiling and Condensation Experiment (FBCE) destined for operation on board of the International Space Station (ISS) Fluid Integrated Rack (FIR). We performed tests with the condensation test module oriented horizontally and vertically. Using FC-72 as the test fluid and water as the cooling fluid, we evaluated the operational characteristics of the condensation module and generated ground based data encompassing the range of parameters of interest to the condensation experiment to be performed on the ISS. During this testing, we also evaluated the pressure drop profile across different components of the fluid subsystem, heater performance, on-orbit degassing subsystem, and the heat loss from different components. In this presentation, we discuss representative results of performance testing of the FBCE flow loop. These results will be used in the refinement of the flight system design and build-up of the FBCE which is scheduled for flight in 2019